Self-assessed health of elderly people in Brussels: does the built environment matter?

Geographical characteristics and influencing factors of the health level of older adults in the Yangtze River Economic Belt, China, from 2010 to 2020

The health of older adults is crucial for the overall health of the entire life cycle. Based on population sampling survey data and census data from 131 prefecture level units in the Yangtze River Economic Belt (YREB) during 2010-2020, this study used exploratory spatial data analysis, geographical detector, stepwise regression analysis, and GTWR model to analyze the spatiotemporal pattern and influencing factors of the health level of older adults in the YREB. The results show that the health level of older adults in the YREB slightly increased from 2010 to 2020, with the most significant improvement in the upstream region and the most significant decline in the midstream region. The older adults' health level in the YREB displays a gradient decreasing pattern of the downstream, midstream, and upstream regions. The health level of older adults in the YREB is influenced by a combination of natural and social environment factors. Areas with lower altitude and moderate humidity climates are more conducive to the health of older adults. The increase in influencing factors such as population migration rate, per capita GDP, average years of education, per capita housing construction area, per capita park green area, and green coverage rate in built-up areas is conducive to improving the health level of older adults, while lower number of health institutions per 1,000 people and higher household support rate are not conducive to improving the health level of older adults. In addition, over time, the health-promoting effect of natural environmental factors is enhanced from 2010 to 2020, and the influence of annual precipitation on shaping the spatial pattern of older adults' health level became more obvious. Although the promoting effect of population migration on the health level of older adults tends to weaken, it remains the primary factor affecting the spatiotemporal differentiation of older adults' health level in the YREB. The impact of social development on the health level of older adults has changed from a positive health effect (improvement) to a negative health effect (loss). The health-promoting effect of living environment factors is enhanced. The health-inhibitory effect of household support rate increased, and showed a gradient decreasing pattern from downstream to midstream to upstream. The findings of this study can provide a more in-depth understanding of the spatiotemporal pattern of the health level of older adults in the YREB and the factors influencing it, improve the health level of older adults in the region, and promote the development of healthy and active aging in the YREB, and improve the human health. At the same time, this study also supplements the related research on aging and the health level of the elderly. Firstly, it can provide reference for the research on the health of old adults in other countries and regions around the world. Secondly, it can also provide a basis for research on aging and the health of old adults in cities and counties under YREB.

Multidimensional health heterogeneity of Chinese older adults and its determinants

Background

Nowadays, the "Healthy China" and "Actively Addressing Population Aging" are two important national strategies in China. Promoting high-quality development of demand-driven older adults health services is an important way to achieve these strategies. From the perspective of active ageing, assessing the health status of older adults from multiple dimensions becomes crucial as it helps identify their specific health service needs, intervention measures, and health policies tailored to this population.

Methods

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) wave 4 (2018). A total of 4190 older adults (aged ≥60 years) were included as the analysis sample. Latent class analysis was performed to categorize older adults based on 6 health indicators, including Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), doctor diagnosed chronic diseases, depressive symptoms, cognitive function, and social participation. Multinomial logistic model was used to explore determinants associated with the various patterns of multidimensional health of older adults.

Results

The multidimensional health of older people was classified into three latent classes: Relatively Healthy (Class 1, n = 2806, 66.97%), Highly Depressed and Relatively Health Risk (Class 2, n = 1189, 28.38%), and Functional Impairment (Class 3, n = 195, 4.65%). Gender, age, education, marital status, number of children, alcohol consumption, physical activity, savings, residence, air quality satisfaction, and medical service satisfaction had significant effects on the attribution of all multidimensional health latent classes.

Conclusion

Heterogeneous and multidimensional health classes exist in China's older population, and these classes are influenced by a variety of factors and to varying degrees. Policymakers and healthcare providers can use these evidence to further address the diverse needs of older adults and improve older-care health services, ultimately achieving the goal of Active Ageing and Healthy China.

Mental health among people with a migration background in Belgium over the past 20 years: how has the situation evolved?

BACKGROUND

Poor mental health is highly stigmatized and stereotyped, even more when it comes to migrant and ethnic minority groups (MEM). Belgium, which has a long history of immigration, is a good case study for analysing how the prevalence of mental illness (MI) has evolved over time and how such evolution had differed between MEM. This paper seeks to explore the prevalence of MI and potential inequalities among MEM compared to native Belgians between 1997 and 2018, shedding light on this important issue.

METHODS

The data set is composed of the six cross-sectional waves of the Belgian Health Interview Survey from 1997 to 2018. The 12-item General Health Questionnaire was used to assess the average level of mental health and the prevalence of MI (score ≥ 4) among five major MEM groups in Belgium (Belgian, Moroccan, Turkish, European migrants, and non-European migrants). Multivariate logistic and linear regression models were used to assess the likelihood of having a MI in the different MEM groups and survey years. The minimal clinically important difference (MID) was also calculated for the severity of MI.

RESULTS

After controlling for socioeconomic status, the average marginal effect indicated a decrease in mental health among Moroccans and Turks in Belgium between 1997 and 2018, compared to Belgians. This result was confirmed by the Chi²-test, which showed that Turkish (χ²=17.75, p < 0.001) and Moroccans respondents (χ²=4.19, p < 0.04) had a higher overall level of mental distress than Belgians. Furthermore, in 2018, even after adjusting for age, sex and education level, having a mother born in a non-EU country increased the risk of mental illness.

CONCLUSIONS

Mental health inequalities between migrant and ethnic groups are on the rise in Belgium. To address this issue, particular attention should be given to the Moroccan and Turkish background populations. Specific interventions and policies must be implemented to prevent the increase of psychological distress among migrants and ethnic minorities, on the one hand, and ensure that high-quality mental health care is accessible to all, regardless of ethnicity, on the other hand. Additionally, we recommend that future research on ethnic mental healthcare includes better data collection on the country of birth of respondents and their parents.

Exploring the Relationship Between Neighborhood-Built Environment and Elderly Health: A Research Based on Heterogeneity of Age and Gender Groups in Beijing

Background

The built environment quality of neighborhoods has a significant impact on the health of the elderly. Although there has been a wealth of studies on low-density Western cities, research on the impacts of built environment on elderly health in high-density Chinese cities is far from sufficient. The pathways by which the built environment affects elderly health remain to be observed, particularly whether such pathways vary for different ages and genders.

Methods

Based on the data of the "Fourth Survey on the Living Conditions of the Elderly in China" in 2015, a sample survey of 3,360 older adults, aged 60 years and over, in Beijing was conducted. We first explored the built environment factors that affect elderly health with a multilevel regression model. We then adopted a multilevel structural equation model (MSEM) to reveal the mediating effect of health activities. Moreover, a stratified analysis was applied to explore the impact of age and gender heterogeneity on the relationship between built environment and elderly health.

Results

(1) Neighborhood-built environment measured within a 500 m buffer area had a higher correlation with elderly health when compared with other areas. (2) Physical activity and social interaction played a mediating role in the correlation between the built environment and elderly health. Even if the interference of residential self-selection was controlled within the subgroups, majority of the built environment elements had significant impacts on elderly health. (3) The impacts of built environment variables on elderly health vary among different age and gender groups. Population density mainly promoted elderly health through health activities in the middle-aged (aged 70-79) group and high-aged (aged 80+) group, and shorter distance to transit stations affects health by promoting the social interaction among high-aged males (aged 80+) group compared to with other groups, and high-quality built environment significantly promotes physical activity to alleviate loneliness only in elderly females.

Conclusion

To effectively boost elderly health by improving the quality of the built environment, adequate considerations should also be given to the differentiated demands of adults of different age and gender groups, precise health behavior interventions should be provided, and the construction of personalized aging-friendly and livable spatial environments should be emphasized to realize healthy and active aging.

The Influence of Pension Mode on the Mental Health of Older Adults-Evidence from Older Adults in China

Successful aging is achieved throughout the life course, and successful aging groups tend to have good psychosocial and physical conditions and are active in social activities. With increasing age, the mental health problems of older adults have become increasingly prominent, and the choice of pension mode is closely related to the mental health of older adults. Starting from the psychological level of the older adult, this paper used data from the 2018 Chinese Longitudinal Healthy Longevity Survey to study the impact of three pension methods on the mental health of older adults. The study found that, at present, there are three types of pension modes in China: living alone, family pension, and institutional care, and family pensions are still the mainstream pension mode. Older adults with deeper negative feelings are more inclined to family pensions than to live alone, but the spiritual comfort provided by family members does not improve the negative feelings of older adults. Institutional care deepens the negative feeling and reduces the positive feeling of older adults. In addition, retirement or pension and medical insurance, as life security in old age, can effectively reduce the negative feelings of old age and promote positive feelings. In view of the present situation of China's pension mode and the psychological characteristics of the older adults, we should further build a perfect family pension security system, promote the personalized service construction of older adult care institutions, promote applicable aging renovation of existing residential areas, and encourage older adults to engage in healthy exercise.

Long-Term Exposure to Residential Greenspace and Healthy Ageing: a Systematic Review

PURPOSE OF REVIEW

We systematically reviewed the available observational evidence on the association between long-term exposure to residential outdoor greenspace and health at older age and rated the evidence as sufficient, limited, or inadequate.

RECENT FINDINGS

We identified 59 studies, ranging from poor to very good quality. The health outcomes included mental health (N = 12, of which three were longitudinal studies and eight were rated to be of good quality), cognitive function (N = 6; two longitudinal studies, five of good/very good quality), physical capability (N = 22; five longitudinal studies, six of good/very good quality), cardiometabolic risk (N = 9; one longitudinal study, five of good/very good quality), morbidity (N = 11; three longitudinal studies, six of good/very good quality) and perceived wellbeing (N = 9; all cross-sectional, two of good quality). The evidence for a beneficial association with greenspace was rated limited for morbidity and inadequate for mental health, cognitive function, physical capability, cardiometabolic risk and perceived wellbeing. The reviewed studies provided inadequate/limited but suggestive evidence for a beneficial association between greater long-term greenspace exposure and healthy ageing. This review highlights the need of longitudinal studies that assess the association between long-term greenspace exposure and the trajectory of objective indicators of ageing.

Environmental characteristics of older people attending physical medicine and rehabilitation outpatient clinics

OBJECTIVE

A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas.

METHODS

The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used.

RESULTS

Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies.

CONCLUSIONS

The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.

Multiple Linear Regression-Structural Equation Modeling Based Development of the Integrated Model of Perceived Neighborhood Environment and Quality of Life of Community-Dwelling Older Adults: A Cross-Sectional Study in Nanjing, China

Due to the poor functioning in daily living activities, community-dwelling older adults spend more time in their neighborhood environment. The perceived neighborhood environment is crucial to their quality of life (QoL). To explore the complex influences of perceived neighborhood environment on QoL, a questionnaire was designed to measure their perception of each factor of neighborhood environment and each domain of QoL. Based on collected data, the reliability test was applied to revise the questionnaire. Multiple linear regression (MLR) and structural equation modeling (SEM) were adopted to hypothesize and test the integrated model for community-dwelling older adults. The results show that community-dwelling older adults' perceptions of neighbor support, facilities related to physical exercise and recreation, and accessibility to facilities impact their overall QoL with diverse coefficients of 0.437, 0.312, and 0.295, respectively; neighbor support (0.207) on physical health; sidewalk condition (0.134), natural environment (0.260), and facilities related to daily life (0.165) on psychological health; and neighbor support (0.298), facilities related to daily life (0.206), and design-related safety (0.225) on social relationship. This revealed that perceptions of neighborhood environment have diverse impacts on their QoL. This study can provide targeted retrofit strategies for communities to enhance QoL of community-dwelling older adults efficiently.

How the Urban Neighborhood Environment Influences the Quality of Life of Chinese Community-Dwelling Older Adults: An Influence Model of “NE-QoL”

Due to functional impairment and low mobility, the sphere of activities of older adults often shrinks and they rely on their living environment more. Especially for urban community-dwelling older adults who are aging in place, the urban neighborhood environment affects their quality of life (QoL) heavily. This study aims to explore how the urban neighborhood environment affects QoL of community-dwelling older adults and develop a mediation model called “Neighborhood Environment-Quality of Life (NE-QoL)” for community-dwelling older adults. The reliability test is applied to test and modify the questionnaire based on cross-sectional data collected from the survey, the multiple regression analysis is used to identify significant influence relations between variables of neighborhood environment and dimensions of the QoL, mediation effects are assumed and tested by the mediation analysis in SPSS, and then the “NE-QoL” is developed to reveal the detailed influence path between the urban neighborhood environment and QoL of community-dwelling older adults. The “NE-QoL” model reveals seven variables of the urban neighborhood environment, which influences the QoL of community-dwelling older adults significantly, and three mediation effects exist in the influence path, making clear the understanding about the relationship between neighborhood environment and the QoL of community-dwelling older adults. It provides valuable retrofit guidelines of the neighborhood environment for improving QoL of community-dwelling older adults.

Healthy urban living: Residential environment and health of older adults in Shanghai

A healthy residential environment, especially for older adults, has emerged as an important issue on political and planning agenda in China. This paper aims to investigate the direct and indirect impact of residential environment on the health of older adults in Shanghai, taking into account health-related behaviours, subjective well-being and socio-demographic factors in one comprehensive conceptual model. Our results show that the residential environment is associated with older adults' health directly, and also indirectly through a series of significant behavioural (physical and social activities) and perceptual (subjective well-being) factors. After combining the direct and indirect association, the results show that good housing and neighbourhood quality and a safe social environment contribute to better subjective, physical and mental health conditions of older adults. In addition, access to cultural facilities is positively related to older adults' mental and physical health and subjective well-being, while a higher proportion of older adults in a neighbourhood appears to promote physical and social activities but not health.

Do Inequalities in Neighborhood Walkability Drive Disparities in Older Adults' Outdoor Walking?

Older residents of high-deprivation areas walk less than those of low-deprivation areas. Previous research has shown that neighborhood built environment may support and encourage outdoor walking. The extent to which the built environment supports and encourages walking is called “walkability”. This study examines inequalities in neighborhood walkability in high- versus low-deprivation areas and their possible influences on disparities in older adults’ outdoor walking levels. For this purpose, it focuses on specific neighborhood built environment attributes (residential density, land-use mix and intensity, street connectivity, and retail density) relevant to neighborhood walkability. It applied a mixed-method approach, included 173 participants (≥65 years), and used a Geographic Information System (GIS) and walking interviews (with a sub-sample) to objectively and subjectively measure neighborhood built environment attributes. Outdoor walking levels were measured by using the Geographic Positioning System (GPS) technology. Data on personal characteristics was collected by completing a questionnaire. The results show that inequalities in certain land-use intensity (i.e., green spaces, recreation centers, schools and industries) in high- versus low-deprivation areas may influence disparities in older adults’ outdoor walking levels. Modifying neighborhood land use intensity may help to encourage outdoor walking in high-deprivation areas.