Neighborhood age structure and cognitive function in a nationally-representative sample of older adults in the U.S

Older Adults Place Greater Importance Than Younger Adults on a Purposeful Retirement

Objective: Regarding retirement, some but not all people decline in sense of purpose, and retirees may view maintaining a sense of purpose as nonessential. These findings suggest individual differences both in the importance placed on being purposeful during retirement in general and the discrepancy for purpose importance prior to and during retirement. Method: This study surveyed U.S. adults (n = 2009, M_age = 48.51) asking them about how they viewed having a purpose in two life stages: before and during retirement, as well as personality and demographic questions. Results: Findings suggest that, overall, people believe it is important to have a purpose and direction during retirement. This tendency was greater among older adults, and those higher on conscientiousness or lower on neuroticism. However, working status did not play a role in the perceived importance of purpose during the retirement period. Moreover, age differentiated who perceives during-retirement purpose as more important than prior-to-retirement purpose. Conclusion: The current findings add to our understanding of when individuals expect to be purposeful and counter the claims that older adults may place less importance on being purposeful. Instead, these findings point to the need for continuing work on how to help older adults maintain or find a purpose in life following retirement.

How Neighborhood Structural and Individual Characteristics Affect Frailty Progression: Evidence from the China Health and Retirement Longitudinal Study

OBJECTIVES

(1) To characterize the average trajectories of frailty over time in Chinese community-dwelling older adults; (2) To assess the effects of neighborhood structural and individual characteristics on frailty progression.

DESIGN

A nationally representative prospective cohort study.

SETTING

Communities in 28 provinces, China.

PARTICIPANTS

6238 respondents aged 60 and above in 447 communities from four waves of the China Health and Retirement Longitudinal Study.

MEASUREMENTS

Frailty was measured using the 61-item Frailty Index (FI).

RESULTS

The trajectory of FI was nonlinear, with an average growth rate of 0.025 that significantly slows down at the rate of 0.002 per year. Older, male, and uninsured respondents showed faster rates of growth in FI over time than younger, female, and insured counterparts. Respondents living in neighborhoods with a higher percentage of the older population and rural villages showed slower rates of growth in FI over time.

CONCLUSION

Expanding health insurance coverage and keeping a high clustering of the elderly in neighborhoods may be the potential strategies for population-level frailty prevention and interventions.

Urban-rural variation in the association between social support availability and cognitive function in middle-aged and older adults: Results from the baseline Tracking Cohort of the Canadian Longitudinal Study on Aging

The purpose of this study was to investigate if and how the associations between social support availability (SSA) and cognitive function varied across urban, rural, and geographical regions in Canada. Data from a population-level sample of community-dwelling adults aged 45-85 years were obtained from the baseline Tracking Cohort of the Canadian Longitudinal Study on Aging. The associations between SSA and two domains of cognitive function, memory and executive function, were analyzed using multilevel regression models. SSA was positively and significantly associated with both executive function and memory. We found SSA had stronger positive associations with executive function among participants living in rural areas compared to urban areas in all geographical regions; however, geographical variation in the associations between SSA and memory were not supported by model results. Understanding how the associations between cognitive function and modifiable risk factors, including SSA, vary across geographical contexts is important for developing policies and programs to support healthy aging.

Individual and environmental factors associated with cognitive function in older people: a longitudinal multilevel analysis

BACKGROUND

Individual and environmental factors have been found to be related to cognitive function. However, few studies have examined the longitudinal effects of both individual and environmental factors over time. The purpose of this study was to examine the effects of individual and environmental factors over time on older people's cognitive function.

METHODS

Nationally representative panel data from the Taiwan Longitudinal Survey on Aging 1999-2015 (n = 6349 persons, observations = 12,042) were used. City-level indicator data were sourced from the government. A multilevel mixed linear model analysis was conducted.

RESULTS

Better cognitive function was significantly related to individuals' work, ethnicity, younger age, higher education level, better self-rated health, higher level of emotional support received, being more religious, higher economic satisfaction, and living in the cities with higher population densities. Education and social connectedness were protective factors over time.

CONCLUSION

Socioeconomics and social connectedness are related to cognitive function. A more social integrated lifestyle and financially secure living is suggested in the policy.

Association of Local Variation in Neighborhood Disadvantage in Metropolitan Areas With Youth Neurocognition and Brain Structure

Importance

Neighborhood disadvantage is an important social determinant of health in childhood and adolescence. Less is known about the association of neighborhood disadvantage with youth neurocognition and brain structure, and particularly whether associations are similar across metropolitan areas and are attributed to local differences in disadvantage.

Objective

To test whether neighborhood disadvantage is associated with youth neurocognitive performance and with global and regional measures of brain structure after adjusting for family socioeconomic status and perceptions of neighborhood characteristics, and to assess whether these associations (1) are pervasive or limited, (2) vary across metropolitan areas, and (3) are attributed to local variation in disadvantage within metropolitan areas.

Design, Setting, and Participants

This cross-sectional study analyzed baseline data from the Adolescent Brain and Cognitive Development (ABCD) Study, a cohort study conducted at 21 sites across the US. Participants were children aged 9.00 to 10.99 years at enrollment. They and their parent or caregiver completed a baseline visit between October 1, 2016, and October 31, 2018.

Exposures

Neighborhood disadvantage factor based on US census tract characteristics.

Main Outcomes and Measures

Neurocognition was measured with the NIH Toolbox Cognition Battery, and T1-weighted magnetic resonance imaging was used to assess whole-brain and regional measures of structure. Linear mixed-effects models examined the association between neighborhood disadvantage and outcomes after adjusting for sociodemographic factors.

Results

Of the 11 875 children in the ABCD Study cohort, 8598 children (72.4%) were included in this analysis. The study sample had a mean (SD) age of 118.8 (7.4) months and included 4526 boys (52.6%). Every 1-unit increase in the neighborhood disadvantage factor was associated with lower performance on 6 of 7 subtests, such as Flanker Inhibitory Control and Attention (unstandardized Β = -0.5; 95% CI, -0.7 to -0.2; false discovery rate (FDR)-corrected P = .001) and List Sorting Working Memory (unstandardized Β = -0.7; 95% CI, -1.0 to -0.3; FDR-corrected P < .001), as well as on all composite measures of neurocognition, such as the Total Cognition Composite (unstandardized Β = -0.7; 95% CI, -0.9 to -0.5; FDR-corrected P < .001). Each 1-unit increase in neighborhood disadvantage was associated with lower whole-brain cortical surface area (unstandardized Β = -692.6 mm2; 95% CI, -1154.9 to -230.4 mm2; FDR-corrected P = .007) and subcortical volume (unstandardized Β = -113.9 mm3; 95% CI, -198.5 to -29.4 mm3; FDR-corrected P = .03) as well as with regional surface area differences, primarily in the frontal, parietal, and temporal lobes. Associations largely remained after adjusting for perceptions of neighborhood safety and were both consistent across metropolitan areas and primarily explained by local variation in each area.

Conclusions and Relevance

This study found that, in the US, local variation in neighborhood disadvantage was associated with lower neurocognitive performance and smaller cortical surface area and subcortical volume in young people. The findings demonstrate that neighborhood disadvantage is an environmental risk factor for neurodevelopmental and population health and enhancing the neighborhood context is a promising approach to improving the health and development of children and adolescents.

Do perceived social neighborhood factors explain the association between neighborhood age composition and mental health among Dutch older adults?

BACKGROUND

In the light of urbanization and aging, a crucially relevant policy question is how to shape neighborhoods to foster healthy aging. An important debate is whether older adults should group in neighborhoods, or whether a more mixed neighborhood age composition is more beneficial to health and well-being. We therefore assessed the association between neighborhood age structure and mental health and the mediating role of individual perceptions of neighborhood social factors.

METHODS

We conducted multivariable linear regression models and causal mediation analyses in 1255 older adults of the Dutch Globe study. The neighborhood age structure was measured in 2011 as the homogeneity of the age composition (using the Herfindahl-Hirschman index, range from 0 to 100, a higher score indicating more homogeneity) and the percentage of specific age groups in a neighborhood. Mental health was measured in 2014 by the Mental Health Inventory-5 score (range 0 to 100, a higher score indicating better mental health). Potential mediators were assessed in 2011 and included perceptions of neighborhood social cohesion, feeling at home in a neighborhood, and social participation.

RESULTS

A more homogeneous age composition (not specified for age) and a higher percentage of children living in a neighborhood were associated with better mental health, the other age categories were not. Social cohesion, feeling at home and social participation did not mediate the associations.

CONCLUSIONS

The neighborhood age composition may be an interesting but currently insufficiently understood entry point for policies to improve older adult's mental health status.

The Foreclosure Crisis, Community Change, and the Cognitive Health of Older Adults

OBJECTIVES

While home foreclosures are often thought of as a household-level event, the consequences may be far-reaching, and spill over to the broader community. Older adults, in particular, could be affected by the spiral of community changes that result from foreclosures, but we know very little about how the foreclosure crisis is related to older adult health, in particular cognition.

METHOD

This article uses growth curve models and data from the Health and Retirement Study matched to Census and county-level foreclosure data to examine whether community foreclosures are related to older adults' cognitive health and the mechanisms responsible.

RESULTS

We find that higher rates of county-level foreclosures are associated with a faster decline in individual cognition at older ages. Although we examined an extensive number of individual and community mechanisms, including individual housing wealth and depressive symptoms, community structural factors, social factors, and perceptions of physical disorder and cohesion, none of the mechanisms examined here explained this relationship.

DISCUSSION

This study shows that the adverse consequences of home foreclosures spill over to the local community, with implications for the cognitive health of older adults.

Neighborhood Age Composition and Self-Rated Health: Findings from a Nationally Representative Study

Neighborhood age composition is an understudied area. Furthermore, existing empirical and conceptual work is conflicting, with some scholarship-indicating neighborhoods with older adults are beneficial and other scholarship suggesting it can be detrimental. Combining data from 7,197 older adults from the first wave (2011) of the National Health & Aging Trends Study and census tract data from the National Neighborhood Change Database, the purposes of our study were to: 1) identify the characteristics of neighborhoods experiencing different types of changes in age composition, and 2) examine the association between neighborhood age composition and self-rated health. Findings indicate that neighborhoods experiencing Concentration (where the number of older adults are declining but their percentage of the total population are increasing), the majority of which are in urban areas, have less aggregate economic resources, more indicators of neighborhood disorder, and less access to services and supports. Regression models also suggest older adults living in Concentration neighborhoods reported lower self-rated health compared to those living in the other three neighborhood types. Findings point to the importance of considering neighborhood age composition when targeting interventions and resources, and the potential consequences of being stuck in place in a neighborhood that does not meet elders' needs.

Social and Built Environments Related to Cognitive Function of Older Adults: A Multi-Level Analysis Study in Taiwan

The purpose of this study was to examine the associations between cognitive function, the city’s social environment, and individual characteristics of older adults. The individual data of older people were from the Nutrition and Health Survey in Taiwan 2013–2016. The participants who were aged 65 and above were included in the analysis (n = 1356). City-level data were obtained for twenty cities in Taiwan. The data of city-level indicators were from governmental open data and Taiwan’s Age Friendly Environment Monitor Study. A multilevel mixed-effect model was applied in the analysis. Population density, median income, safety in the community, barrier-free sidewalks, high education rate of the population, low-income population rate, household income inequality, and elderly abuse rate were related to cognitive function in the bivariate analysis. When controlling for individual factors, the city’s low-income population rate was still significantly related to lower cognitive function. In addition, the participants who were at younger age, had a higher education level, had a better financial satisfaction, had worse self-rated health, had higher numbers of disease, and had better physical function had better cognitive function. Social and built environments associated with cognitive function highlight the importance of income security and the age friendliness of the city for older adults. Income security for older people and age-friendly city policies are suggested.

Psychological distress links perceived neighborhood characteristics to longitudinal trajectories of cognitive health in older adulthood

RATIONALE

Perceived neighborhood characteristics have been linked to cognitive health in older adulthood. The pathways through which neighborhood characteristics could influence cognition in older adulthood, however, have not been fully explored. Poorer quality neighborhoods may negatively influence cognition through feelings of psychological distress.

OBJECTIVE

To examine whether perceived neighborhood physical disorder and social cohesion were associated with change in episodic memory and semantic verbal fluency through anxiety and depressive symptoms.

METHODS

Using the Health and Retirement Study (HRS; n = 13,919), mediation models were conducted. Change in cognition (episodic memory and semantic verbal fluency) were modeled using latent growth curve models.

RESULTS

Higher physical disorder was associated with worse initial episodic memory and verbal fluency through greater anxiety symptoms. Higher social cohesion was associated with better initial episodic memory and verbal fluency through both lower anxiety and fewer depressive symptoms. Further, individuals with higher social. cohesion reported lower anxiety and in turn, showed a slower rate of verbal fluency decline. A direct effect of physical disorder on initial episodic memory remained, after accounting for indirect effects and covariates.

CONCLUSIONS

Overall, individuals who live in neighborhoods with high physical disorder and low social cohesion may experience greater psychological distress. Symptoms of anxiety and depression may, in turn, interfere with cognitive functioning. Neighborhood characteristics may be an important, targetable area for intervention to improve not only mental health outcomes, but cognitive health outcomes in older adulthood.

Unique Effects of Perceived Neighborhood Physical Disorder and Social Cohesion on Episodic Memory and Semantic Fluency

OBJECTIVE

Objective measures of neighborhood quality are associated with physical and mental health outcomes for older adults, but the relationship between perceived neighborhood quality and cognitive health has not been fully explored. Furthermore, positive and negative neighborhood characteristics may influence cognition through different mechanisms. The present study aimed to determine whether perceptions of neighborhood quality predict cognitive functioning in two domains, above and beyond individual-level risk factors, in a nationally representative sample of older adults.

METHOD

Using cross-sectional weighted data from 13,919 participants aged 51 and older from the Health and Retirement Study, linear regression models tested independent associations between perceived neighborhood quality (physical disorder and social cohesion) and cognition (episodic memory and semantic verbal fluency), controlling for sociodemographic characteristics, chronic disease burden, and depressive symptoms. Interaction terms tested whether neighborhood social cohesion moderated the relationship between neighborhood physical disorder and each cognitive outcome.

RESULTS

Perception of greater neighborhood physical disorder was significantly associated with worse episodic memory, while perception of lower neighborhood social cohesion was significantly associated with worse semantic fluency. There were no significant interactions between physical disorder and social cohesion.

CONCLUSIONS

Results provide preliminary evidence for different mechanisms underlying associations between aspects of neighborhood quality and cognition (e.g., stress vs. social interaction). Additional intervention work is needed to determine whether improving neighborhood physical conditions and promoting social cohesion at the neighborhood level could reduce cognitive morbidity among older adults.

Premature natural menopause and cognitive function among older women in Indonesia

We examine the association between premature natural menopause and cognitive function among older women in Indonesia. Data come from Indonesia Family Life Survey (IFLS) 2014 (N = 1,031 menopausal women). Multilevel ordered logistic regression was used to take into account unobserved factors in the women's communities, also considering a range of potential confounding factors including their reproductive histories, lifestyles, and sociodemographic characteristics. The findings show that premature natural menopause was significantly associated with lower cognitive function in later life (ß = -0.97, P< .01, CI -1.61-(-0.33)). The findings were robust against potential confounding factors including reproductive history, lifestyle, and sociodemographic characteristics.

Can physical activity attenuate the negative association between sitting time and cognitive function among older adults? A mediation analysis

The purpose of this study was to examine the combined association of sitting time and physical activity with cognitive function and to determine whether moderate-to-vigorous physical activity (MVPA) is a mediator of the association between sitting time and cognitive function in a nationally representative sample of older adults from Chile. Data from 989 older adults (≥65 years old, 61.3% female) from the 2009-2010 Chilean Health Survey were analyzed. Physical activity and sitting time were measured using the Global Physical Activity questionnaire. Cognitive function was assessed using the modified Mini-Mental State levels Examination. Physical activity levels were categorized as "inactive" (<600 metabolic equivalent value minutes per week) or "active" (≥600 metabolic equivalent value minutes per week). Sitting time was categorized as "sedentary", defined as ≥4 h of reported sitting time per day, or "non-sedentary", defined as <4 h. We created the following groups (i) non-sedentary/active; (ii) non-sedentary/inactive; (iii) sedentary/active; and (iv) sedentary/inactive. Hayes's PROCESS macro was used for the simple mediation analysis. Compared with the reference group (individuals classified as non-sedentary/active), older adults who were classified as sedentary/active had elevated odds of cognitive impairment (OR = 1.90, [95% CI, 1.84 to 3.85]). However, the odds ratio for cognitive impairment was substantially increased in those classified as sedentary/inactive (OR = 4.85 [95% CI, 2.54 to 6.24]) compared with the reference group. MVPA was found to mediate the relationship between sitting time and cognitive function (Indirect Effect = -0.070 [95% CI, -0.012 to -0.004]).

CONCLUSION

The present findings suggest that, whether overall physical activity is high or low, spending large amounts of time sitting is associated with elevated odds of cognitive impairment and that MVPA slightly weakens the relationship between sitting time and cognitive function.

Sex-specific association between neighborhood characteristics and dementia: The Three-City cohort

INTRODUCTION

The living environment affects general health and may influence cognitive aging; however, the relationships between neighborhood characteristics and dementia are still poorly understood.

METHODS

We used data from a French population-based prospective study (the Three-City cohort) that included 7016 participants aged 65 years and older with a 12-year follow-up. We used principal components analysis of neighborhood composition indicators to construct the Three-City deprivation score. To study its impact on dementia incidence, we performed survival analyses using a marginal Cox model to take into account intraneighborhood correlations. As interaction with sex was significant, analyses were stratified by sex.

RESULTS

Even after controlling on individual factors, women living in deprived neighborhoods were at higher risk of dementia (hazard ratio = 1.29, 95% confidence interval 1.00-1.67) and Alzheimer's disease (hazard ratio = 1.42, 95% confidence interval 1.09-1.84). No association was found for men.

DISCUSSION

Living in a deprived neighborhood is associated with higher risk of dementia in women.