Neighborhood environment in studies of health of older adults: a systematic review

Unlocking the night: Exploring the health impacts of night-time walking environments on health outcomes of older adults

Walking remains the primary form of physical activity for many older adults in China, and the quality of the walking environment at night may determine the frequency and duration of evening outings. This study reveals how night-time environmental features influence the health outcomes of older adults. Using the medical check-up records of 87,578 older adults from a public health service in the Beilin district of Xi'an city, China, the role of the night-time walking environment in managing chronic conditions was examined. A favorable night-time walking environment reduced the prevalence of chronic conditions and comorbidities among older adults. However, the health effects stemming from the night-time walking environment exhibited heterogeneity, with significant impacts only on metabolic conditions, such as hypertension and diabetes, while the effects on other conditions were not significant. Our findings supplement the theory of healthy aging by highlighting the potential value of the environment in managing chronic conditions, which may serve as a cost-effective health intervention for aging societies.

Effect of pre- and post-migration neighborhood environment on migrants' mental health: the case of Shenzhen, China

Existing mental health studies usually disregard people's neighborhood experiences in the past, which may have long-lasting mental health effects. This may particularly be true for migrants. To assess how the perceived pre- and post-migration neighborhood environment shapes migrants' mental health later on in life, a quasi-longitudinal survey (N = 591) among migrants was conducted in Shenzhen, China. The risk of poor mental health was screened with the General Health Questionnaire (GHQ). Perceptions of the pre- and post-migration neighborhood environment were measured retrospectively and assessed with structural equation models. The results show that the direct pathways linking the perceived post-migration neighborhood physical (NPE) and social environment (NSE) to migrants' mental health are significant. No direct association is found between the pre-migration neighborhood environments and mental health. The indirect path between the pre-migration NPE/NSE and mental health is significantly mediated by the post-migration NPE and NSE. Migrants' SES development and their neighborhood attainment interplay overtime which have long-term impacts on their mental health. Our findings suggest that the pre-migration neighborhood plays a crucial role in migrants' mental health. This confirms a path dependency of migrants' neighborhood environment throughout their migrations. Future mental health studies are advised to incorporate neighborhood characteristics along migrants' residential histories.

Neighborhood poverty and hopelessness in older adults: The mediating role of perceived neighborhood disorder

Hopelessness is one of the strongest predictors of health and mortality, particularly for older populations. Prior research has found associations between individual-level socioeconomic factors and hopelessness, but less is known about the potential importance of neighborhood-level socioeconomic contexts for hopelessness. In particular, the role of neighborhood disorder as a potential explanatory factor for poor psychological well-being remains underexplored. This study investigates whether neighborhood poverty is associated with a sense of hopelessness among older adults and if perceived neighborhood disorder mediates the link between poverty and hopelessness. Individual-level data came from the 2014/2016 Health and Retirement Study and were merged with neighborhood-level poverty data from the 2012-2016 and 2014-2018 American Community Survey. Linear regression models were employed to examine the association between neighborhood poverty, disorder, and hopelessness. Respondents in neighborhoods with higher poverty levels reported a greater sense of hopelessness (b = 0.11, 95% CI = 0.08, 0.15, p < .001), controlling for individual-level sociodemographic and health characteristics. Greater perceived neighborhood disorder was also positively associated with a sense of hopelessness (b = 0.16, 95%CI = 0.14, 0.18). When we included both neighborhood poverty and disorder in the same model, the association between neighborhood poverty and hopelessness was reduced by two thirds (b = 0.04, 95%CI = 0.0003, 0.07), while the association between perceived disorder and hopelessness remained robust (b = 0.16, 95%CI = 0.14, 0.18). We further examined the formal mediating effects of neighborhood disorder using structural equation modeling. The total effect of neighborhood poverty on hopelessness was significant (β = 0.08, bootstrapped 95%CI = 0.05, 0.10). The direct effect of neighborhood poverty was not significant (β = 0.02, bootstrapped 95% CI = -0.01, 0.04), while the indirect effect through neighborhood disorder was significant (β = 0.06, bootstrapped 95% CI = 0.05, 0.07). Neighborhood disorder mediated 75% of the association between neighborhood poverty and hopelessness. In light of these findings, improving neighborhood conditions, such as signs of disorder, may alleviate feelings of hopelessness in older adults residing in impoverished neighborhoods.

Social support moderates association between area deprivation index and changes in physical health among adults in the Baltimore Study of Black Aging (BSBA)

Despite the association of neighborhood quality with poorer adult health, limited research has explored the association between neighborhood disadvantage, e.g. Area Deprivation Index (ADI), and older Black adults' health, prospectively. This observational study examined the association between ADI and changes in longitudinal physical health within older Black adults. The analytic sample (n = 317) included data from waves 1 & 2 of the Baltimore Study of Black Aging: Patterns of Cognitive Aging (BSBA-PCA). Study variables included the Area Deprivation Index (ADI), objective (e.g. average heart rate) and subjective (e.g. activities of daily living) measures of physical health. Multiple linear regression models were conducted controlling for sociodemographic and social support characteristics. Participants living in more disadvantaged neighborhoods, based on national and state ADIs, were more likely to have a decreasing heart rate even after adjusting for covariates. Likewise, participants reporting increasing levels of ADL difficulty were living in a neighborhood with greater disadvantage based on national and state ADI rankings. Significant social support received and ADI (national and state) interactions were observed for average heart rate. The findings suggest that research on the effect of neighborhood quality and social support can enhance our understanding of its impact on older Black adults' health prospectively.

Age differences in the moderating effects of neighbourhood disadvantage on the relationship between physical activity and cognitive function: A longitudinal analysis of the Canadian Longitudinal Study on Aging

OBJECTIVES

To explore whether the association between physical activity (PA) and cognition is moderated by neighbourhood disadvantage, and whether this relationship varies with age.

STUDY DESIGN

A longitudinal analysis of the Canadian Longitudinal Study on Aging, wherein we included participants (N = 41,599) from urban areas who did not change their residential postal code from baseline (2010-2015) to first follow-up (2015-2018).

MAIN OUTCOME MEASURES

At baseline, we measured PA using the Physical Activity Scale for the Elderly, and neighbourhood disadvantage using the Material and Social Deprivation Indices.

RESULTS

Using latent change score regression models, we determined that higher PA at baseline was independently associated with greater maintenance in memory performance from baseline to first follow-up both for adults aged 45-64 (B = 0.04, SE = 0.01, p = 0.001) and for those aged 65+ years (B = 0.12, SE = 0.02, p < 0.001). For participants aged 45-64 years, greater material deprivation was independently associated with declines in memory performance (B = -0.10, SE = 0.03, p < 0.001). In addition, greater social deprivation was associated with a stronger effect of PA on changes in executive functions (B = 0.17, SE = 0.08, p = 0.025) for adults aged 45-64 years; greater material deprivation was associated with a stronger effect of PA on changes in memory performance (B = 0.07, SE = 0.03, p = 0.022). We failed to detect any interactions between PA and neighbourhood disadvantage among adults aged 65+ years (all p values >0.05).

CONCLUSION

For middle-aged adults, the benefits of PA on cognitive performance may be strongest among adults living with greater neighbourhood social and material disadvantages. For older adults, PA may be beneficial to cognitive performance irrespective of neighbourhood disadvantages.

Age-related shifts in mental health determinants from a deprived area in the European Union: informing the national healthy aging program of Hungary

Mental disorders are among the leading causes of disability worldwide, disproportionately affecting older people. This study aims to assess the mental health of elderly individuals living in a deprived region of Hungary, and to identify and estimate the weight of different determinants of mental health across different age groups. A cross-sectional study was conducted with randomly selected samples of individuals (n = 860) aged 18 years and older in Northeast Hungary. The World Health Organization Well-Being Index (WHO-5), the single-item Life Satisfaction Scale, and the 12-item General Health Questionnaire (GHQ-12) were used to measure mental health of the participants. Multiple linear regression analysis was performed to measure the association between sociodemographic and health-related variables and mental health. Overall, the mean WHO-5 score was 69.2 ± 18.1 and it showed a significant decrease by age (p < 0.001), with the lowest score observed in aged 75 years and above (p < 0.001). The mean life satisfaction score was 7.5 ± 1.9 and it showed a significant decreasing trend over the life course (p < 0.001). The highest level of psychological distress as assessed by GHQ-12 was observed in the group aged 75 years or older (11.5 ± 6.0, p < 0.001). Multiple linear regression indicated that self-reported financial status, social support, sense of control over their health, activity limitation and pain intensity were the most important determinants of mental health among older adults. Interventions to improve the mental health of older adults should focus on the positive impact of social support, the reduction of financial insecurity and the use of effective pain relief medications.

Social Deprivation and Multimorbidity Among Community-Based Health Center Patients in the United States

Introduction

Multimorbidity - having 2 or more chronic diseases - is a national public health concern that entails burdensome and costly care for patients, their families, and public health programs. Adults residing in socially deprived areas often have limited access to social and material resources. They also experience a greater multimorbidity burden.

Methods

We conducted a retrospective cohort analysis of electronic health record (EHR) data from 678 community-based health centers (CHCs) in 27 states from the Accelerating Data Value Across a National Community Health Center (ADVANCE) Network, a clinical research network, from 2012-2019. We used mixed-effects Poisson regression to examine the relationship of area-level social deprivation (eg, educational attainment, household income, unemployment) to chronic disease accumulation among a sample of patients aged 45 years or older (N = 816,921) residing across 9,362 zip code tabulation areas and receiving care in safety-net health organizations.

Results

We observed high rates of chronic disease among this national sample. Prevalence of multimorbidity varied considerably by geographic location, both within and between states. People in more socially deprived areas with Social Deprivation Index (SDI) scores in quartiles 2, 3, and 4 had greater initial chronic disease counts - 17.1%, 17.7%, and 18.0%, respectively - but a slower rate of accumulation compared with people in the least-deprived quartile. Our findings were consistent for models of the composite SDI and those evaluating disaggregated measures of area-level educational attainment, household income, and unemployment.

Conclusion

Social factors play an important role in the development and progression of multimorbidity, which suggests that an assessment and understanding of area-level social deprivation is necessary for developing public health strategies to address multimorbidity.

Socio-spatial trajectories and health disparities among older adults in Chile

In this study, we examine residential trajectories since birth among older adults in the Santiago Metropolitan Area, Chile, and their association with health outcomes. We linked retrospective residential information for a sample of 802 individuals aged 65-75 in 2019 to context-based information from decennial censuses. Our analysis reveals substantive heterogeneity in individuals' residential trajectories, thus mirroring social and urban changes in Chile's largest city. We found significant associations between residential histories and health outcomes at the time of the interview. Consistent residence in advantaged areas was linked to better health, whereas relocating to the metropolitan area from elsewhere was generally linked to poorer health, except for those moving to emerging middle-class areas. These findings underscore the importance of longitudinal and life course approaches in understanding the complex relationship between place and health.

Gender differences in the subjective wellbeing of the older adults and the determinant factors: a case study of Nanjing

Objective

This paper aims to examine the gendered differences in the subjective wellbeing of older adults and underlying determinant factors which contribute to these differences in China where the unique social and cultural systems, the consequent concept of filial piety and the perceptions towards different living arrangements in later life provide an excellent laboratory for studying the topic.

Methods

Hierarchical linear models are employed to analyze the impacts of household structure and built environment on the subjective wellbeing of older adults based on a survey conducted in Nanjing in 2021.

Results

There are significant gender differences in the subjective wellbeing of older adults, with older women reporting higher levels of subjective wellbeing (4.95 vs.4.69). Gender differences also exist in how the built environment affects the subjective wellbeing of older adults, with a greater impact on older adult women (33.68% vs. 28.50%). Household structure impacts the subjective wellbeing of older adults through the division of housework and the company of family members.

Conclusion

There are three major mechanisms through which gender affects the subjective wellbeing of older adults, including structural mechanisms, socio-cultural mechanisms, and physiological mechanisms. Targeted environmental interventions and urban planning policies are recommended to promote the subjective wellbeing of older adults.

Neighborhood environment and quality of life of older adults in eastern Nepal: findings from a cross-sectional study

INTRODUCTION

Quality of life (QoL) is a subjective measure reflecting individuals' evaluations based on their personal goals and values. While global research shows the role of neighborhood factors like ethnic diversity and socio-cultural dynamics on QoL, these are unexplored in the Nepali context. Therefore, this study examined the relationship between neighborhood environment and QoL among Nepali older adults in eastern Nepal.

METHODS

This cross-sectional study involved 847 non-institutionalized older adults (aged ≥ 60 years) from two districts in eastern Nepal. QoL was evaluated using the 13-item brief Older People's Quality of Life questionnaire, where a mean score of < 3 indicated low/poor QoL. The neighborhood environment, conceptualized across three domains (demographic, socio-cultural, and built environment), included ethnic diversity, connections with family, friends, and neighbors, cultural ties, residential stability, and rurality. Their association with QoL was examined using multivariable logistic regression.

RESULTS

Around 20% of older adults reported poor QoL. Higher ethnic diversity (adjusted Odds Ratio [aOR] = 0.12, 95% confidence interval [CI]: 0.04-0.36), moderate contact with family and relatives (aOR = 0.26, CI: 0.11-0.61), and high contact with neighbors (aOR = 0.09, CI: 0.03-0.21) were associated with lower odds of poor QoL. Conversely, high contact with friends (aOR = 2.29, CI: 1.30-4.04) and unstable residence (OR = 6.25, CI: 2.03-19.23) increased the odds of poor QoL. Additionally, among the covariates, chronic disease, tobacco use, unemployment, and lack of education were also significantly associated with poor QoL.

CONCLUSION

Overall, the demographic environment, socio-cultural factors, and the built environment of the neighborhood influence QoL. Therefore, diversifying the neighborhood's ethnic composition, promoting social connections such as frequent contact with family, relatives, and neighbors, and ensuring residential stability can enhance the QoL of older adults.

Moderating Role of Neighborhood Environment in the Associations Between Hearing Loss and Cognitive Challenges Among Older Adults: Evidence From US National Study

This study examined the associations between hearing loss and cognitive challenges among community-dwelling older adults and whether neighborhood characteristics (physical disorder and low social cohesion) moderated the associations. Cross-sectional national data from Round 11 of the National Health and Aging Trends Study were adopted (N = 2,515). Multinomial logistic regressions were used to examine associations among variables and interactive analyses were conducted to examine moderating effects. Results indicated significant relationships between the experience of hearing loss and possible dementia and between severe or profound hearing loss and probable dementia. Interactive models suggested that residing in neighborhoods with physical disorder and low social cohesion were negatively associated with possible dementia among older adults with moderate and severe or profound hearing loss, respectively, compared to those without hearing loss. Findings underscore the necessity of environmental and social interventions to enhance cognitive health among older adults with varying degrees of hearing challenges.

Validity assessment of oral health promotion activities targeting the older population for community care in South Korea: A Delphi study

OBJECTIVE

The purpose of this study was to establish an oral health activity assessment tool for older people and evaluate its validity.

BACKGROUND

To provide reasonable and efficient oral health promotion services with limited medical resources, a tool including categories and items of oral health promotion activities for older people should be prepared.

MATERIALS AND METHODS

The tool initially consisted of 76 items on oral health promotion activities for older people classified into assessment-performance-evaluation stages. Topics for each stage included general and oral health, daily health, oral health status, behaviour, and awareness. In addition, two Delphi surveys were conducted on 10 experts who met the selection criteria, and the final items were derived based on the review opinions.

RESULTS

As a result of the first and second Delphi surveys, the content validity for all items was ≥0.60 and the content validity index was ≥0.80. In the first survey, the degree of convergence in some items was 0-0.88. After modifying the contents according to expert opinions, the degree of convergence was improved from 0 to 0.50 in the second survey. The degree of agreement ranged from 0.75 to 1.00, indicating that experts agreed. Finally, a total of 65 items were derived.

CONCLUSION

A 65-item tool was derived through two Delphi surveys for the assessment of oral health activities for older people. The use of the tool developed in this study would likely contribute to better prevention of oral diseases and the promotion of oral health among older people.

Does Neighborhood Socioeconomic Status Alter Memory Change Associated with a Cancer Diagnosis? Preliminary Evidence from the US Health and Retirement Study

BACKGROUND

Neighborhood disadvantage has been linked to cognitive impairment, but little is known about the effect of neighborhood disadvantage on long-term cancer-related memory decline.

METHODS

Incident cancer diagnosis and memory (immediate and delayed recall, combined with proxy-reported memory) were assessed at biennial interviews in the US Health and Retirement Study (N = 13,293, 1998-2016). Neighborhood disadvantage was measured using the National Neighborhood Data Archive disadvantage index, categorized into tertiles (T1: least disadvantaged-T3: most disadvantaged). Linear mixed-effects models estimated the standardized memory trajectories in participants with or without cancer, by neighborhood disadvantage.

RESULTS

Living in more disadvantaged neighborhoods was associated with worse mean memory function and steeper memory declines, regardless of cancer status. An incident cancer diagnosis was associated with an acute memory drop for those living in least disadvantaged neighborhoods but not more disadvantaged neighborhoods [T1: -0.05, 95% confidence interval (CI): -0.08, -0.01; T3: -0.13, 95% CI: -0.06, 0.03]. Cancer survivors in the least disadvantaged neighborhoods had a slight memory advantage in the years prior to diagnosis (T1: 0.09, 95% CI: 0.04, 0.13) and after diagnosis (T1: 0.07, 95% CI: 0.01, 0.13).

CONCLUSIONS

An incident cancer diagnosis among those living in the least disadvantaged neighborhoods was associated with an acute memory drop at the time of diagnosis and a long-term memory advantage before and after diagnosis compared with cancer-free individuals in similar neighborhoods.

IMPACT

These findings could inform interventions to promote cancer survivor's long-term aging. Future studies should investigate the social and biological pathways through which neighborhood socioeconomic status could influence cancer-related memory changes.

Aging in climate change: Unpacking residential mobility and changes of social determinants of health in southern United States

The southern coastal states of the United States are susceptible to extreme weather and climate events. With growing move-in and -out older populations in the region, health implications of their residential mobility lack sufficient knowledge. Using 126,352 person-level records from 2012 to 2021, we examined geospatial and temporal patterns of older populations' residential mobility, considering the changing social determinants of health and disparities. We found the moves of older populations with socioeconomic or health disadvantages were related to increased exposure to environmental hazards and reduced access to health resources. The findings inform targeted strategies for climate adaptation that address the needs of vulnerable aging populations.

Who Are the Stakeholders in Promoting Mental Health?

Background

It is now confirmed that mental health promotion policies need innovations beyond the scope of the health sector. In this study, an attempt was made to identify the most effective stakeholders of the public sector in the field of mental health promotion in Iran to help the policy-makers and to encourage inter-sectoral collaboration and further involvement of these effective sectors in mental health promotion plans.

Methods

This was a mixed-methods study. From the first step (literature review and a survey), the names of public agencies affected by mental health promotion were extracted. In the next step, a checklist for identifying the main stakeholders was developed. The data of this step were analyzed by the simple additive weighting method. Ultimately, a table was plotted in the form of institutional mapping in order to summarize the organizations affecting each risk factor of mental health promotion.

Results

The Islamic Consultative Assembly, the Ministry of Interior, the Islamic Republic of Iran Broadcasting, the Ministry of Cooperatives, Labor, and Social Welfare, and the Ministry of Education were identified as the five institutions with the greatest impacts on the social determinants of mental health in Iran.

Conclusion

Significant impacts can be exerted by institutions such as the Islamic Consultative Assembly (as the legislator), the Ministry of Interior, and its subsidiary entities such as municipalities and governors (as the administrators of homeland security and support for safe and appropriate urban and local facilities), the Islamic Republic of Iran Broadcasting (as the national media), the Ministry of Cooperatives, Labor, and Social Welfare (as the institution in charge of employment, job security, and social welfare), and the Ministry of Education (as the educational institution of the country).

Associations of role, area deprivation index, and race with health behaviors and body mass index among localized prostate cancer patients and their partners

PURPOSE

To examine the associations of role (localized prostate cancer (PCa) patient vs. their intimate partner), area deprivation index (ADI-higher scores indicating higher neighborhood deprivation levels), and race (Black/African American (AA) vs. White) with health behaviors and body mass index (BMI) among PCa patients and partners. The behaviors include smoking, alcohol consumption, diet quality, sedentary behaviors, and physical activity (PA).

METHODS

This study used the baseline data collected in a clinical trial. Given the nested structure of the dyadic data, multi-level models were used.

RESULTS

Significant role-race interaction effects on smoking, ADI-race effects on alcohol consumption, and role-ADI effects on BMI were found. Meanwhile, patients smoked more cigarettes, decreased alcohol consumption, had less healthful diets, spent longer time watching TV, did fewer sedentary hobbies, had more confidence in PA, and had higher BMIs than their partners. High ADI was independently associated with lower odds of drinking alcohol, using computer/Internet, and doing non-walking PA, and higher BMI compared to low ADI controlling for role and race. Black/AA dyads had less smoking amount and alcohol consumption and higher sedentary time and BMI than White dyads when adjusted for role and ADI.

CONCLUSIONS

This study identified significant interaction and main effects of role, ADI, or race on health behaviors and BMI.

IMPLICATIONS FOR CANCER SURVIVORS

Future behavioral interventions should address divergent individual needs between patients and partners, social and neighborhood barriers, and cultural indicators of racial groups to promote healthful behaviors and improve the quality of survivorship for PCa patients and partners.

Developing Problematic Performance Value Scores: Binding Routine Activity Performance, Environmental Barriers, and Health Conditions

BACKGROUND

Community design features, such as sidewalks and street crossings, present significant challenges for individuals with disabilities, hindering their physical performance and social integration. However, limited research has been conducted on the application of Universal Design (UD) to address these challenges, particularly concerning specific demographic groups and population cohorts. Understanding the influence of environmental features on physical performance is crucial for developing inclusive solutions like UD, which can enhance usability and social integration across diverse populations.

OBJECTIVE

This study aims to bridge this gap by investigating the complex relationships between environmental barriers, health conditions, and routine activity performance. An index was developed to evaluate users' UD performance based on functional capacity, providing scientifically rigorous and objectively measured evidence of UD effectiveness in creating inclusive built environments.

METHOD

Using data from the Problematic Activities Survey (PAS) conducted in the U.S., Canada, and Australia and targeting individuals with and without functional limitations, multinomial logit models were employed to estimate the probabilities of encountering performance problems. This analysis led to the development of the Problematic Performance Value (PPV) score.

RESULTS

The results demonstrated significant disparities in PPVs across various health conditions, particularly concerning curb ramps. Individuals facing mobility issues in their legs/feet, arms/hands, or back/neck encounter more pronounced challenges, especially when curb ramps lack proper design elements. Similarly, individuals with vision impairments face heightened difficulties with traffic signals, particularly due to issues with audible signal systems. These findings underscore the importance of addressing micro-level environmental challenges to accommodate individuals with varying functional capacities effectively.

CONCLUSIONS

By providing insights into the most problematic daily activities encountered by diverse populations, the PPV score serves as a valuable indicator for guiding environmental design improvements and promoting equitable space usage. This can be used to guide improved UD solutions and decide areas of concentration by providing generalized information on specific environmental features that contribute to user performance.

Built environment and loneliness in later life: productive engagement as the pathway

OBJECTIVES

The built environment is increasingly recognized as being associated with late-life loneliness. However, the pathway remains understudied. This study investigated the mediating effects of productive engagement in relationships between the built environment and loneliness.

METHODS

We conducted a cross-sectional analysis of data from 4,409 community-dwelling people aged 65 years and above in China. We employed the Chinese version of the De Jong Gierveld Loneliness Scale to assess loneliness. The built environment comprises residential density, street connectivity, park-based and vegetation-based green space, land use mix, and the number of and distance to the nearest recreational, health, shopping and community services within 300-meter and 500-meter buffer areas. Structural equation modeling was used.

RESULTS

Only green space (parks) had a direct effect on loneliness. Residential density and green space (parks) had an indirect effect on loneliness through volunteering. The number of recreational services had an indirect effect on loneliness through recreational and sporting activities, although distance to the nearest recreational services did not. All the significant results were only found within 300-meter rather than 500-meter buffers.

CONCLUSIONS

Our findings have implications for environmental gerontology theory and practice. Providing more green space and recreational services can significantly improve older adults' helping behavior, social activities and sporting activities, which can further reduce older adults' loneliness.

Use of Long-Term Care Services by Older Persons with Limited English Proficiency

Older migrants face special difficulties in the access and use of long-term care services and supports (LTSS). Our study was designed to examine how older persons with limited English proficiency (LEP) in two groups of migrants (Spanish or Chinese speaking) interact with the LTSS system. Focus groups were used to elicit information from members of these groups. We discovered Chinese elders were likely to believe that the LTSS services could, if managed properly, meet their needs, while the Spanish speakers were more skeptical. These differences were associated with the presence of trusted intermediaries among the Chinese elders who could represent their interests, while most Spanish speakers did not report having such intermediaries. In this way, trust, or lack of it, was uncovered as the key element defining older adults' interactions with the formal health and social service systems. Findings will be used to develop a modeling method that will allow us to analyze results in a manner that can be extended to use with other migrant groups.

Association between neighborhood poverty and ovarian reserve: the ovarian aging study

OBJECTIVE

This study aimed to examine the association between neighborhood poverty and ovarian reserve.

METHODS

Among 1,019 healthy premenopausal women in the Ovarian Aging Study, aggregate exposure to neighborhood poverty was examined in relation to biomarkers of ovarian reserve, antimüllerian hormone (AMH) and antral follicle count (AFC). Specifically, the interaction of age-x-neighborhood poverty was assessed cross-sectionally to determine whether AMH and AFC declines across women may be greater in women exposed to more neighborhood poverty. Neighborhood poverty was assessed by geocoding and linking women's residential addresses in adulthood to US Census data.

RESULTS

Independent of covariates, a significant interaction term showed the association between age and AMH varied by degree of exposure to neighborhood poverty in adulthood ( b = -0.001, P < 0.05). AMH declines increased progressively across women exposed to low, medium, and high levels of neighborhood poverty. In addition, main effects showed that higher neighborhood poverty was related to higher AMH in the younger women only ( b = 0.022, P < 0.01). Results related to AFC were all nonsignificant ( P > 0.05).

CONCLUSIONS

Across women, greater aggregate exposure to neighborhood poverty in adulthood was related to lower ovarian reserve, indexed by AMH. In addition, there was a positive association between neighborhood poverty and AMH in younger women that attenuated in the older women. Together, results suggest that neighborhood disadvantage may have detrimental impacts that manifest as initially higher AMH, resulting in greater ovarian follicle loss over time. However, it remains unclear whether these results examining differences across women may replicate when AMH declines by neighborhood poverty are examined longitudinally.

Neighborhood Deprivation and Changes in Oral Health in Older Age: A Longitudinal Population-Based Study

The aim of this study was to examine the extent to which neighborhood-level socioeconomic factors (objective and perceived) are associated with poor oral health in older adults over time, independent of individual socioeconomic position. Data for this cross-sectional and longitudinal observation study came from a socially and geographically representative cohort of men aged 71 to 92 y in 2010-12 (n = 1,622), drawn from British general practices, which was followed up in 2018-19 (aged 78-98 y; N = 667). Dental measures at both times included number of teeth, periodontal pocket depth, self-rated oral health, and dry mouth. Neighborhood deprivation was based on Index of Multiple Deprivation (IMD) and a cumulative index measuring perceptions about local environment. Individual-level socioeconomic position was based on longest-held occupation. Multilevel and multivariate logistic regressions, adjusted for relevant sociodemographic, behavioral, and health-related factors, were performed to examine the relationships of dental measures with IMD and perceived neighborhood quality index, respectively. Cross-sectionally, risks of tooth loss, periodontal pockets, and dry mouth increased from IMD quintiles 1 to 5 (least to most deprived); odds ratios (ORs) for quintile 5 were 2.22 (95% confidence interval [CI], 1.41-3.51), 2.82 (95% CI, 1.72-4.64), and 1.51 (95% CI, 1.08-2.09), respectively, after adjusting for sociodemographic, behavioral, and health-related factors. Risks of increased pocket depth and dry mouth were significantly greater in quintile 5 (highest problems) of perceived neighborhood quality index compared to quintile 1. Over the 8-y follow-up, deterioration of dentition (tooth loss) was significantly higher in the most deprived IMD quintiles after full adjustment (OR for quintile 5 = 2.32; 95% CI, 1.09-4.89). Deterioration of dentition and dry mouth were significantly greater in quintile 5 of perceived neighborhood quality index. Neighborhood-level factors were associated with poor oral health in older age, both cross-sectionally and longitudinally, particularly with tooth loss, and dry mouth, independent of individual-level socioeconomic position.

Systematic Review of Longitudinal Evidence and Methodologies for Research on Neighborhood Characteristics and Brain Health

Objective: Synthesize longitudinal research evaluating neighborhood environments and cognition to identify methodological approaches, findings, and gaps. Methods: Included studies evaluated associations between neighborhood and cognition longitudinally among adults >45 years (or mean age of 65 years) living in developed nations. We extracted data on sample characteristics, exposures, outcomes, methods, overall findings, and assessment of disparities. Results: Forty studies met our inclusion criteria. Most (65%) measured exposure only once and a majority focused on green space and/or blue space (water), neighborhood socioeconomic status, and recreation/physical activity facilities. Similarly, over half studied incident impairment, cognitive function or decline (70%), with one examining MRI (2.5%) or Alzheimer's disease (7.5%). While most studies used repeated measures analysis to evaluate changes in the brain health outcome (51%), many studies did not account for any type of correlation within neighborhoods (35%). Less than half evaluated effect modification by race/ethnicity, socioeconomic status, and/or sex/gender. Evidence was mixed and dependent on exposure or outcome assessed. Conclusion: Although longitudinal research evaluating neighborhood and cognitive decline has expanded, gaps remain in types of exposures, outcomes, analytic approaches, and sample diversity.

The impact of residential environment on older people's capabilities to live independently: a survey in Beijing

BACKGROUND

Studies have shown how environmental factors influence older people's health and functional limitations, which are crucial for achieving healthy aging. However, such a healthy aging model has been criticized for defining health as an absence of disease, because chronic conditions cannot be reversed through medical treatments. In response to such critiques, this study refers to Huber's positive health definition, arguing that health should not be defined as the absence of disease but as the ability to adapt and self-manage in the face of social, physical, and emotional challenges. There is a need to develop a community-based approach to healthy aging that considers how the residential environment enables older people to adapt and self-manage. Drawing on Sen's capability approach, this study proposes that such a community-based approach should provide a supportive environment to enable older people's capabilities to live independently.

METHODS

Using hierarchical multiple regression analysis of data from 650 older people (60 years and older) surveyed in Beijing, we unravel which features of the residential environment support older people' s capabilities to live independently and how these impacts differ depending on older people's frailty levels.

RESULTS

The results show that four environmental factors, namely perceived accessibility (B = 0.238, p < 0.001 for physical capability, B = 0.126, p < 0.001 for social capability, B = 0.195, p < 0.001 for psychological capability), pleasant surroundings (B = 0.079, p < 0.05 for physical capability, B = 0.065, p < 0.05 for social capability), meeting opportunities (B = 0.256, p < 0.001 for social capability, B = 0.188, p < 0,001 for psychological capability, and life convenience B = 0.089, p < 0.05 for physical capability, B = 0.153, p < 0.001 for psychological capability) positively affect older people's capabilities to live independently. These four environmental factors cause differences in older people's capabilities between different neighborhood types. Moderation analysis shows that meeting opportunities are more relevant for frail older people (B = 0.090, p < 0.001 for social capability, B = 0.086, p < 0.01 for psychological capability).

CONCLUSIONS

This study contributes to the literature by emphasizing the role of supportive residential environments in enabling older people to live independently. Furthermore, we identify four environmental factors that support older people's capabilities. Results can be used to develop effective community-based environmental support to enable older people to live independently.

Comparison across age groups of causes, circumstances, and consequences of falls among individuals living in Canada: A cross-sectional analysis of participants aged 45 to 85 years from the Canadian Longitudinal Study on Aging

Falls are a leading cause of injury-related deaths and hospitalizations among Canadians. Falls risk has been reported to be increased in individuals who are older and with certain health conditions. It is unclear whether rurality is a risk factor for falls. This study aimed to investigate: 1) fall profiles by age group e.g., 45 to 54 years, 55 to 64 years, 65 to 74 years, 75 to 85 years; and 2) falls profiles of individuals, by age group, living in rural versus urban areas of Canada. Data (N = 51,338) from the Canadian Longitudinal Study on Aging was used to examine the relationship between falls and age, rurality, chronic conditions, need for medical attention, and fall characteristics (manner, location, injury). Self-reported falls within a twelve-month period occurred in only 4.8% (single fall) and 0.8% (multiple falls) of adults. Falls were not related to rural residence or age, but those with memory impairment, multiple sclerosis, as well as other chronic conditions such as mood disorder, anxiety disorder, and hyperthyroidism not often thought to be associated with falls, were also more likely to fall. Older individuals were more likely to fall indoors or fall while standing or walking. In contrast, middle-aged individuals were more likely to fall outdoors or while exercising. Type of injury was not associated with age, but older individuals were more likely to report hospitalization after a fall. This study shows that falls occur with a similar frequency in individuals regardless of age or urban/rural residence. Age was associated with fall location and activity. A more universally applicable multi-facted approach, rather than one solely based on older age considerations, to screening, primary prevention and management may reduce the personal, social, and economic burden of falls and fall-related injuries.

State variation in neighborhood COVID-19 burden across the United States

BACKGROUND

A lack of fine, spatially-resolute case data for the U.S. has prevented the examination of how COVID-19 infection burden has been distributed across neighborhoods, a key determinant of both risk and resilience. Without more spatially resolute data, efforts to identify and mitigate the long-term fallout from COVID-19 in vulnerable communities will remain difficult to quantify and intervene on.

METHODS

We leveraged spatially-referenced data from 21 states collated through the COVID Neighborhood Project to examine the distribution of COVID-19 cases across neighborhoods and states in the U.S. We also linked the COVID-19 case data with data on the neighborhood social environment from the National Neighborhood Data Archive. We then estimated correlations between neighborhood COVID-19 burden and features of the neighborhood social environment.

RESULTS

We find that the distribution of COVID-19 at the neighborhood-level varies within and between states. The median case count per neighborhood (coefficient of variation (CV)) in Wisconsin is 3078.52 (0.17) per 10,000 population, indicating a more homogenous distribution of COVID-19 burden, whereas in Vermont the median case count per neighborhood (CV) is 810.98 (0.84) per 10,000 population. We also find that correlations between features of the neighborhood social environment and burden vary in magnitude and direction by state.

CONCLUSIONS

Our findings underscore the importance that local contexts may play when addressing the long-term social and economic fallout communities will face from COVID-19.

Spatial Analysis of Home and Community-Based Services and Number of Deaths Among Older Adults in Taiwan

This study examined the geographical distribution of home- and community-based services (HCBS) resources in Taiwan's Long-Term Care 2.0 policy and explored its association with the number of deaths among older adults. The main outcome of the study was determination of the number of deaths among older adults in townships (N = 346) in 2021. The results showed that home-based HCBS had a significant positive association with mortality among older adults; moreover, community-based and complementary services, which are highly clustered within a township and among its neighbors, exert a significant protective effect on mortality among older adults. Stratified analyses showed a significantly lower mortality among older adults using adult foster care and transportation services, but a significantly higher mortality among older adults using home-based professional care and respite care services, after considering the sociodemographic characteristics of older adults, urbanization, and the number of long-term care resources in the spatial analysis.

The 'Double Risk' of Aging: Examining Vulnerability and (Un)supportive Built Environments in Canadian Cities

The confluence of rapid population aging and the overwhelming desire of older adults to age in place begs the question: Do our cities support the health and well-being of aging populations? Using a neighbourhood-by-neighbourhood approach, this macro-scale investigation explores the "double risk" that many older adults live with - the potential of being disadvantaged by socio-demographic risk factors (being older, living alone, low income) and by living in an unsupportive built environment. It is an integration of what we know about supportive built form for older adults and applies this knowledge to Canadian cities, using a spectrum approach to classifying built environments. We found that most older adults with socio-demographic risk factors are living in unsupportive built environments in Canada; however, the distribution between built environments along the spectrum and between municipalities reveals a variegated landscape of double risk. Previous research suggests that unsupportive built environments can be supplemented with services, small-scale improvements in the built environment, and larger-scale retrofitting of neighbourhoods. Since the spatial distribution of vulnerability varies greatly within the 33 Canadian cities analysed, it highlights the need for this kind of inquiry to target age-friendly policy interventions.

Perceived Neighborhood Characteristics and Later-Life Pain Outcomes: Evidence From the Health and Retirement Study

Objectives: This study examines whether perceived neighborhood characteristics relate to pain outcomes among middle-aged and older adults. Methods: Data were from the Health and Retirement Study (2006-2014; n = 18,814). Perceived neighborhood characteristics were physical disorder, social cohesion, safety, and social ties. We fitted adjusted generalized estimating equation models to evaluate prevalence, incidence, and recovery of moderate-to-severe limiting pain 2 years later. Results: The mean age of our sample was 65.3 years; 54.6% were female and 24.2% reported moderate-to-severe limiting pain at baseline. Positive neighborhood characteristics were associated with low prevalence (e.g., prevalence ratio [PR]: .71 for disorder) and reduced incidence (e.g., PR: .63 for disorder) of moderate-to-severe limiting pain. Positive neighborhood characteristics were associated with a high recovery rate from moderate-to-severe limiting pain (e.g., PR = 1.15 for safety), though the 95% CIs for disorder and cohesion crossed the null. Discussion: Neighborhood characteristics may be important determinants in predicting pain in later life.

Loneliness Among Low-Income Older Immigrants Living in Subsidized Senior Housing: Does Perceived Social Cohesion Matter?

This study compared the level of loneliness among older immigrants residing in subsidized senior housing with that of non-immigrant residents. The study also sought to examine the differential influence of perceived social cohesion on loneliness among these groups. 231 study participants were recruited from subsidized senior housing in St. Louis and the Chicago area. Multiple regression analyses showed that there was a significant difference in loneliness between immigrants and non-immigrants (b = .3, SE = 0.150, p < .05). Also, perceived social cohesion was negatively associated with loneliness (b=-.102, SE = .022, p < .001). Furthermore, immigration status moderated the relationship (b=-.147, SE = .043, p < .01), showing immigrants may benefit more from higher perceived social cohesion in terms of loneliness. The results suggest that perceived social cohesion may act as an important community-level protective factor against loneliness, particularly for older immigrants residing in subsidized senior housing. Creating socially cohesive environments, particularly for this subgroup, could be a crucial strategy for mitigating loneliness.              .

Prioritizing a research agenda on built environments and physical activity: a twin panel Delphi consensus process with researchers and knowledge users

BACKGROUND

The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners).

METHODS

Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin 'top 10' lists of the most important research needs.

RESULTS

From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT.

CONCLUSIONS

Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

Residential Segregation, Perceived Neighborhood Environment, and All-Cause Mortality Among Community-Dwelling Older Chinese Americans

OBJECTIVES

Residential segregation profoundly affects mental and physical health. However, impacts of residential segregation and other neighborhood characteristics on health among older Asian Americans are not fully understood. This study aimed to close this gap by examining effects of residential segregation, perceived neighborhood cohesion, and neighborhood disorder on all-cause mortality among older Chinese immigrants, as well as testing whether the association between residential segregation and mortality would be mediated by perceived neighborhood cohesion and neighborhood disorder.

METHODS

Data were drawn from a subsample of 3,094 older Chinese Americans aged 60 and older (mean age = 72.8 years) from the Population Study of Chinese Elderly in Chicago. Residential segregation was derived using 2010-2014 American Community Survey data. Participants completed surveys on perceived neighborhood cohesion and neighborhood disorder between 2011 and 2013. All-cause mortality was tracked until December 2021.

RESULTS

Residential segregation was associated with elevated all-cause mortality risk; this association, however, was no longer statistically significant after controlling for sociodemographic, behavioral, and health covariates. Perceived neighborhood cohesion, but not neighborhood disorder, was significantly associated with decreased mortality risks. There were no indirect effects of residential segregation on all-cause mortality through perceived neighborhood cohesion or neighborhood disorder. These effects were consistent across male and female participants.

DISCUSSION

These results suggest the importance of neighborhood social environment, specifically perceptions of neighborhood cohesion, in influencing mortality risk among older Chinese immigrants. The findings also indicate the need to conduct further research to examine the health impact of residential segregation among this population.

Neighborhood Built Environments and Health in Later Life: A Literature Review

Objectives: This literature review aims to assess the current state of the field linking neighborhood environments to later-life health and wellbeing. Methods: We used electronic databases (e.g., PubMed, Google Scholar, and ProQuest) to search for studies published between 2010 and 2022 examining associations between neighborhood built environmental variables and later-life physical, cognitive, mental, and social health outcomes. Results: Among 168 studies reviewed, the majority were quantitative (n = 144) and cross-sectional (n = 122). Neighborhood environmental variables significantly associated with later-life health outcomes included population density/rurality, walkability/street connectivity, access to services and amenities, neighborhood quality and disorder, and parks/green/blue/open space. Neighborhoods operated through behavioral and biological pathways including hazardous exposures, affective states (e.g., stress and restoration), and lifestyle (e.g., exercise, socialization, and diet). Discussion: Neighborhoods and healthy aging research is a burgeoning interdisciplinary and international area of scholarship. Findings can inform upstream community interventions and strengthen clinical care.

Changes in neighborhood physical and social environments matter for change in mental health: Longitudinal evidence from Dutch panel data

Numerous neighborhood environments have been recognized to affect mental health, but only a few longitudinal studies investigated these associations jointly and whether different population groups are affected differently. We used three-wave panel data of 2699 adults between 2010 and 2016 in the Netherlands to assess the associations between changes in neighborhood physical and social environments and mental health changes. Further, we assessed possible effect modification of gender and income. Mental health was measured using the Mental Health Inventory. Time-varying exposure to green space, blue space, population density, air pollution, socioeconomic deprivation, and social fragmentation were assigned based on individuals' neighborhood histories. Fixed-effect regressions were conducted to assess within-person associations between single and multiple exposures on mental health for the entire sample and stratified by gender and income. Our single-exposure models showed that increases in blue space were significantly associated with mental health improvements, while increases in fine particulate matter (PM2.5) resulted in declines in mental health. These associations were not attenuated in the multi-exposure model. We observed no significant associations for the remaining environments. Stratification analyses showed that females' mental health further declined as PM2.5 concentrations increased compared to males. Increasing levels of socioeconomic deprivation were associated with further declines in mental health among the less well-off compared with higher-income earners. Our longitudinal findings suggested that neighborhood physical and social environment changes were associated with mental health changes. Future research is required to establish the underlying pathways.

Association of census-tract level gentrification and income inequality with 6-year incidence of metabolic syndrome in the Hispanic Community Health Study/Study of Latinos, an epidemiologic cohort study

BACKGROUND

Metabolic syndrome varies by socio-demographic characteristics, with younger (18-29 years) and older (50-69 years) Hispanic/Latino having higher prevalence compared to other groups. While there is substantial research on neighborhood influences on cardiometabolic health, there are mixed findings regarding the effects of gentrification and few studies have included Hispanic/Latinos. The role of neighborhood income inequality on metabolic health remains poorly understood.

OBJECTIVES

Examined associations of neighborhood gentrification and income inequality with metabolic syndrome (MetSyn) using data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

DESIGN, SETTING AND PARTICIPANTS

The HCHS/SOL is a community-based cohort of adults of Hispanic/Latinos (aged 18-74). Analyses included 6710 adults who did not meet criteria for MetsS at baseline (2008-2011) and completed the visit 2 examination (2014-2017). Poisson regressions estimated odds ratios (IRR) and 95% confidence intervals (CI) for neighborhood gentrification and change in income inequality with MetSyn incidence.

MAIN OUTCOME AND EXPOSURE MEASURES

Gentrification was measured with an index that included changes (2000 to 2006-2010) in education, poverty, and income. Change in neighborhood income inequality (2005-2009 to 2012-2016) was measured using the Gini coefficient of income distribution. MetSyn was defined using National Cholesterol Education Program Adult Treatment Panel III criteria.

RESULTS

Among 6647 Hispanic/Latino adults, 23% (N = 1530) had incident MetSyn. In models adjusted for socio-demographic, health insurance status, and neighborhood characteristics, gentrification (IRR, 1.00, 95%CI, 0.96-1.03) and income inequality change (IRR, 1.00, 95%CI, 0.99-1.00) were not associated with MetSyn at visit 2. There was no association between cross-sectional income inequality (2005-2009) and MetSyn at visit 2 (IRR, 0.97, 95%CI, 0.82-1.15).

CONCLUSION

Neighborhood gentrification and income inequality change were not associated with incidence of MetSyn over 6 years among Hispanic/Latino adults. This study demonstrated that income-based residential changes alone may not be sufficient to explain neighborhood influences on health outcomes among this population.

The Price of Growing Up in a Low-Income Neighborhood: A Scoping Review of Associated Depressive Symptoms and Other Mood Disorders among Children and Adolescents

Neighborhoods, as built and social environments, have significant implications for mental health. Children raised in high-poverty neighborhoods, who are disproportionately Black, Indigenous, and people of color, have a greater risk of adverse life outcomes. Neighborhood gentrification is also salient when examining mental health outcomes as neighborhood economic contexts shift around a child. This review scopes, describes, synthesizes, and critiques the existing literature on the relationship between neighborhood poverty/gentrification and mood disorder symptoms among children ages 3-17 in the United States (U.S.). Given the history of structural racism in the creation of U.S. neighborhoods, inclusion criteria required that study samples be racially diverse. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, seven databases and grey literature were searched; 17 studies were included (total n = 122,089). Fourteen studies found significant associations between neighborhood poverty/gentrification and child depression. Three longitudinal studies found significant results suggesting that childhood neighborhood poverty/gentrification may have a lagged effect, with depression emerging later in life. Neighborhood poverty and gentrification require further examination as social determinants of mental health. Researchers should examine neighborhood poverty and gentrification as social determinants of mental health. Policies that reduce neighborhood economic disparities are needed across the U.S.

Perceived Neighborhood Racial Composition and Depressive Symptoms Among Black Americans Across Adulthood: Evaluating the Role of Psychosocial Risks and Resources

Objectives: To evaluate the relationships between perceived neighborhood racial composition (PNRC), psychosocial risks and resources, and depressive symptoms among young (ages 22-35), middle-aged (ages 36-49), and older (ages 50+) Black Americans. Methods: Full sample and age-stratified linear regression models estimated the PNRC-depressive symptoms association and the extent to which it persisted after accounting for psychosocial risks (i.e., neighborhood disorder, other social stressors) and resources (i.e., mastery, social support, racial identity) among 627 Black Americans in the Nashville Stress and Health Study. Results: Living in racially integrated and predominately White neighborhoods was associated with elevated depressive symptoms. While psychosocial risks and resources explained a substantial portion of these associations, patterns varied across age groups. Discussion: PNRC impacts depressive symptoms among Black Americans by shaping psychosocial risks and resources. Findings underscore interconnections between contextual and psychosocial factors, as well as the distinct mental health significance of these processes across stages of adulthood.

Impact of educational attainment on time to cognitive decline among marginalized older adults: Cohort study of 20,311 adults

BACKGROUND

The effect of years of education on the maintenance of healthy cognitive functioning may differ by race and ethnicity given historical and ongoing inequities in educational quality.

METHODS

We examined 20,311 Black, Latinx, and White adults aged 51-100 from the Health and Retirement Study (2008-2016). Telephone Interview for Cognitive Status-27 data was used to measure cognitive functioning. Generalized additive mixed models were stratified by race and ethnicity and educational attainment (≥12 vs. <12 years). Selected social determinants of health, all-cause mortality, time-varying health and healthcare utilization characteristics, and study wave were included as covariates.

RESULTS

On average, Black and Latinx adults scored lower at baseline compared to White adults regardless of educational attainment (p < 0.001), with a significant overlap in the distributions of scores. The rate of cognitive decline was non-linear for Black, Latinx, and White adults (p < 0.001), and a period of stability was witnessed for those with higher educational attainment irrespective of race and ethnicity. Compared to Black, Latinx, and White adults with lower educational attainment, higher-educated White adults received the greatest protection from cognitive decline (13 years; 64 vs. 51), followed by Latinx (12 years; 67 vs. 55), and Black adults (10 years; 61 vs. 51). Latinx adults experienced cognitive decline beginning at a later age.

CONCLUSIONS

The extent to which higher educational attainment protects adults from cognitive decline differs by race and ethnicity, such that higher-educated White adults received a greater benefit than higher-educated Black or Latinx adults.

Beside the Seaside: Reflections on Local Green and Blue Spaces from Adults Aged over 50 in a Coastal Community

This qualitative study examined the perceptions of potential wellbeing benefits of local green and blue spaces for adults aged over 50 years in a coastal town in North West England. At a population level, living close to green and blue spaces is associated with better mental and physical health, with the strength of the benefits being inversely related to the economic prosperity of an area. However, living in economically disadvantaged coastal communities may be associated with poorer health and wellbeing, particularly for older adults, despite the proximity to blue (and often green) space. Exploring this apparent paradox was the aim of the present study. Through semi-structured interviews with members of a community group, we gained insight into lived experiences of local green and blue spaces. The main themes we developed from analysis of the conversations were accessibility, amenities, social connections, quality of environment, and recuperation and escape. Our findings illustrate that participants valued natural spaces that were local and accessible, particularly when they felt connected to them, and were less likely to visit spaces that were further away and that were perceived as being less welcoming or accessible. This study provides insights into the experiences of adults aged over 50 living in coastal areas and suggests that policies and interventions aimed at promoting wellbeing in this demographic should consider the value of hyper-local green and blue spaces and their potential to promote connectedness to nature.

Effect of built environment on BMI of older adults in regions of different socio-economic statuses

Background

Numerous studies have ignored the influence of underdeveloped urban surroundings on the physical health of China's ageing population. Lanzhou is a typical representative of a less developed city in China.

Methods

This study investigated the relationship between body mass index (BMI) and built environment amongst older adults in regions of different socio-economic statuses (SES) using data from medical examinations of older adults in Lanzhou, as well as calculating community built environment indicators for regions of different SES based on multiple linear regression models.

Results

Results showed that age and underlying disease were negatively associated with overall older adult BMI in the study buffer zone. Land use mix, number of parks and streetscape greenery were positively associated with older adult BMI. Street design and distance to bus stops were negatively connected in low SES regions, but population density and street design were negatively correlated in high SES areas.

Conclusion

These findings indicate that the built environment of SES regions has varying impacts on the BMI of older persons and that planners may establish strategies to lower the incidence of obesity amongst older adults in different SES locations.

Contributions of neighborhood social environment and air pollution exposure to Black-White disparities in epigenetic aging

Racial disparities in many aging-related health outcomes are persistent and pervasive among older Americans, reflecting accelerated biological aging for Black Americans compared to White, known as weathering. Environmental determinants that contribute to weathering are poorly understood. Having a higher biological age, measured by DNA methylation (DNAm), than chronological age is robustly associated with worse age-related outcomes and higher social adversity. We hypothesize that individual socioeconomic status (SES), neighborhood social environment, and air pollution exposures contribute to racial disparities in DNAm aging according to GrimAge and Dunedin Pace of Aging methylation (DPoAm). We perform retrospective cross-sectional analyses among 2,960 non-Hispanic participants (82% White, 18% Black) in the Health and Retirement Study whose 2016 DNAm age is linked to survey responses and geographic data. DNAm aging is defined as the residual after regressing DNAm age on chronological age. We observe Black individuals have significantly accelerated DNAm aging on average compared to White individuals according to GrimAge (239%) and DPoAm (238%). We implement multivariable linear regression models and threefold decomposition to identify exposures that contribute to this disparity. Exposure measures include individual-level SES, census-tract-level socioeconomic deprivation and air pollution (fine particulate matter, nitrogen dioxide, and ozone), and perceived neighborhood social and physical disorder. Race and gender are included as covariates. Regression and decomposition results show that individual-level SES is strongly associated with and accounts for a large portion of the disparity in both GrimAge and DPoAm aging. Higher neighborhood deprivation for Black participants significantly contributes to the disparity in GrimAge aging. Black participants are more vulnerable to fine particulate matter exposure for DPoAm, perhaps due to individual- and neighborhood-level SES, which may contribute to the disparity in DPoAm aging. DNAm aging may play a role in the environment "getting under the skin", contributing to age-related health disparities between older Black and White Americans.

Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls Among Postmenopausal Women: The Women's Health Initiative

PURPOSE

This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence.

METHODS

The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n = 161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships.

RESULTS

NSES was associated with falling before adjustment (high vs. low, odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio, 0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling.

CONCLUSIONS

Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.

The Role of Ethnic Community Social Capital in the Association between Acculturation and Psychological Distress among Older Korean Americans

Guided by the theories of social capital and stress-buffering, we examined how the association between low acculturation and poor mental health among older immigrants would be modified by social capital in ethnic communities (social cohesion, social engagement, perceived ethnic density, and the quality of social interaction). Using data from the Study of Older Korean Americans (N = 2,150, Mean age = 73.4), direct and interactive effect models were examined. Lower acculturation was associated with a greater level of psychological distress, and their link was modified by social cohesion (β = .19, p < .01) and negative social interactions (β =  - .97, p < .01). Findings suggest that the mental health risk associated with low acculturation could be intensified when older immigrants perceive low sense of cohesion in their ethnic communities or have negative interactions with ethnic community members.

State Variation in Neighborhood COVID-19 Burden: Findings from the COVID Neighborhood Project

A lack of fine, spatially-resolute case data for the U.S. has prevented the examination of how COVID-19 burden has been distributed across neighborhoods, a known geographic unit of both risk and resilience, and is hampering efforts to identify and mitigate the long-term fallout from COVID-19 in vulnerable communities. Using spatially-referenced data from 21 states at the ZIP code or census tract level, we documented how the distribution of COVID-19 at the neighborhood-level varies significantly within and between states. The median case count per neighborhood (IQR) in Oregon was 3,608 (2,487) per 100,000 population, indicating a more homogenous distribution of COVID-19 burden, whereas in Vermont the median case count per neighborhood (IQR) was 8,142 (11,031) per 100,000. We also found that the association between features of the neighborhood social environment and burden varied in magnitude and direction by state. Our findings underscore the importance of local contexts when addressing the long-term social and economic fallout communities will face from COVID-19.

Neighborhood Conditions and Social Network Turnover among Older Adults

Increasing research highlights heterogeneity in patterns of social network change, with growing evidence that these patterns are shaped in part by social structure. The role of social and structural neighborhood conditions in the addition and loss of kin and non-kin network members, however, has not been fully considered. In this paper, we argue that the residential neighborhood context can either facilitate or prevent the turnover of core network relationships in later life - a period of the life course characterized by heightened reliance on network ties and vulnerability to neighborhood conditions. Using longitudinal data from the National Social Life, Health, and Aging Project linked with data from the American Community Survey, we find that higher levels of neighborhood concentrated disadvantage are associated with the loss of older adults' kin and non-kin network members over time. Higher levels of perceived neighborhood social interaction, however, are associated with higher rates of adding non-kin network members and lower rates of adding kin network members over time. We suggest that neighborhood conditions, including older adults' perceptions of neighborhood social life, represent an underexplored influence on kin and non-kin social network dynamics, which could have implications for access to social resources later in the life course.

Neighborhood Social Environment and Self-Perceptions of Aging

Background and Objectives

Self-perceptions of aging (SPA) are associated with health and well-being later in life. Although prior studies have identified individual-level predictors of SPA, the role of neighborhood social context in SPA remains largely unexplored. A neighborhood social environment may act as a critical avenue for older adults to remain healthy and socially active, contributing to their evaluations of how they grow old. The present study aims to fill the previous research gap by examining the relationship between neighborhood social environment and SPA, and how age may moderate this relationship. This study is guided by Bronfenbrenner's Ecology of Human Development theory and Lawton's Ecological Model of Aging, positing that an individual's aging experience is deeply rooted in their residential environment.

Research Design and Methods

Our sample includes 11,145 adults aged 50+ from the 2014 and 2016 waves of the Health and Retirement Study. We included 4 social and economic aspects of neighborhoods: (1) neighborhood poverty; (2) percentage of older adults; (3) perceived social cohesion; and (4) perceived disorder.

Results

Multilevel linear regression models showed that respondents in neighborhoods with higher percentages of the older population and with perceptions of high neighborhood disorder reported more negative SPA. Those who perceived their neighborhoods as more socially cohesive reported more positive SPA. Controlling for individual socioeconomic and health status, only neighborhood social cohesion remained significant. We also found significant interaction effects between neighborhood social cohesion and age: The effects of neighborhood cohesion on SPA were stronger in middle age than in old age.

Discussion and Implications

Our findings provide insights into how neighborhood social context is associated with SPA, suggesting that a socially cohesive neighborhood may be important to promote more favorable perceptions of aging, particularly for middle-aged residents.

The neighborhood context and all-cause mortality among older adults in Puerto Rico

Background

Recent efforts have been made to collect data on neighborhood-level attributes and link them to longitudinal population-based surveys. These linked data have allowed researchers to assess the influence of neighborhood characteristics on the health of older adults in the US. However, these data exclude Puerto Rico. Because of significantly differing historical and political contexts, and widely ranging structural factors between the island and the mainland, it may not be appropriate to apply current knowledge on neighborhood health effects based on studies conducted in the US to Puerto Rico. Thus, we aim to (1) examine the types of neighborhood environments older Puerto Rican adults reside in and (2) explore the association between neighborhood environments and all-cause mortality.

Methods

We linked data from the 2000 US Census to the longitudinal Puerto Rican Elderly Health Conditions Project (PREHCO) with mortality follow-up through 2021 to examine the effects of the baseline neighborhood environment on all-cause mortality among 3,469 participants. Latent profile analysis, a model-based clustering technique, classified Puerto Rican neighborhoods based on 19 census block group indicators related to the neighborhood constructs of socioeconomic status, household composition, minority status, and housing and transportation. The associations between the latent classes and all-cause mortality were assessed using multilevel mixed-effects parametric survival models with a Weibull distribution.

Results

A five-class model was fit on 2,477 census block groups in Puerto Rico with varying patterns of social (dis)advantage. Our results show that older adults residing in neighborhoods classified as Urban High Deprivation and Urban High-Moderate Deprivation in Puerto Rico were at higher risk of death over the 19-year study period relative to the Urban Low Deprivation cluster, controlling for individual-level covariates.

Conclusions

Considering Puerto Rico's socio-structural reality, we recommend that policymakers, healthcare providers, and leaders across industries to (1) understand how individual health and mortality is embedded within larger social, cultural, structural, and historical contexts, and (2) make concerted efforts to reach out to residents living in disadvantaged community contexts to understand better what they need to successfully age in place in Puerto Rico.

Perceptions of neighborhood environment and loneliness among older Chinese adults: the mediator role of cognitive and structural social capital

OBJECTIVE

This study aimed to examine the mediating role of social capital in the association between perceived physical neighborhood environment and loneliness among older adults in urban China.

METHOD

Data were derived from face-to-face interviews with people (n = 472) aged 60 or older in urban communities of Shanghai, China, in 2020. Loneliness was measured by the 6-item De Jong Gierveld Scale. A multiple mediator model was adopted to examine the research hypotheses.

RESULTS

Cognitive social capital played a full mediation role in the association between perceived community health care (β = -.061, p < .05), safety (β = -.168, p < .001), recreational services (β = -.058, p < .05), and loneliness. Structural social capital was associated with loneliness (β = -.102, p < .05), whereas its mediator effect was not significant. Perceived transportation convenience had neither a direct nor an indirect effect on loneliness among older adults.

CONCLUSION

Findings indicate that older adults' perceptions of healthcare services, safety, and recreational resources could help alleviate their loneliness via fostering cognitive social capital. Interventions improving older adults' perceptions of community health care, safety, and recreation, and their social capital level could help reduce the prevalence of loneliness.

Neighborhood built environments and cognition in later life

Objectives: Maintaining good cognition is crucial in later life. However, most existing research has focused on individual factors impacting cognition, and few studies have investigated the association between neighborhood built environment and older adults' cognition. This study examined the association between neighborhood built environment and cognition among community-dwelling older adults and identified variations in this association between different age groups in the older population.Methods: Data were derived from a cross-sectional survey of 1873 people aged 65 years and above in Hong Kong. We merged individual data from the survey with neighborhood built environment data based on community auditing and geographical information system. After controlling for individual covariates, we used multivariable linear regression to examine the association between neighborhood built environment and cognition.Results: Residents aged 80 and younger in neighborhoods with a higher land-use mix and more public transport terminals exhibited better cognition. Only the number of community centers in a neighborhood was positively associated with cognition for people older than 80.Conclusion: The built environment creates diverse impacts on different age groups among older adults. Our findings provide useful information for urban planners and policymakers for planning community facilities and built environments that consider the needs of different age groups within the older population.

Neighborhood and Depressive Symptoms in Older Adults Living in Rural and Urban Regions in South Korea

Neighborhoods have a significant impact on depressive symptoms in older adults. In response to the increasing depression of older adults in Korea, this study aims to identify the relationship between perceived and objective neighborhood characteristics in depressive symptoms and find differences between rural and urban areas. We used a National survey collected in 2020 of 10,097 Korean older adults aged 65 and older. We also utilized Korean administration data for identifying the objective neighborhood characteristics. Multilevel modeling results indicated that depressive symptoms decreased when older adults perceived their housing condition (b = -0.04, p < 0.001), their interaction with neighbors (b = -0.02, p < 0.001), and overall neighborhood environment (b = -0.02, p < 0.001) positively. Among the objective neighborhood characteristics, only nursing homes (b = 0.09, p < 0.05) were related to depressive symptoms of older adults living in urban areas. For older adults living in rural areas, the number of social workers (b = -0.03, p < 0.001), the number of senior centers (b = -0.45, p < 0.001), and nursing home (b = -3.30, p < 0.001) in the neighborhood were negatively associated with depressive symptoms. This study found that rural and urban areas have different neighborhood characteristics related to older adults' depressive symptoms in South Korea. This study encourages policymakers to consider neighborhood characteristics to improve the mental health of older adults.

Education, neighborhood environment, and cognitive decline: Findings from two prospective cohort studies of older adults in China

INTRODUCTION

The impacts of education on cognitive decline across different neighborhood environments (NEs) have rarely been studied.

METHODS

We investigated and compared the associations between educational attainment and cognitive decline using data of 1286 participants from the Taizhou Imaging Study (TIS) and the Shanghai Aging Study (SAS).

RESULTS

Compared with low-educated participants, in TIS with disadvantaged NE, high-educated participants manifested a significantly slower decline in global cognition (.062 Z score per year, P < .001), memory (.054 Z score per year, P < .05), and attention (.065 Z score per year, P < .01), whereas in SAS with advanced NE, highly educated individuals exhibited a slower decline only in attention (.028 Z score per year, P < .05).

DISCUSSION

We observed the additive effect of educational attainment and NE on cognitive decline in older adults. Education is especially important for maintaining cognitive health in a disadvantaged environment.