Associations Among Neighborhood Characteristics, Mobility Limitation, and Social Participation in Late Life

Neighborhood Walkability, Walking Difficulties, and Participation in Leisure Activities Among Older People: A Cross-Sectional Study and 4-Year Follow-Up of a Subsample

Objectives: To study cross-sectional and longitudinal associations between objectively assessed neighborhood walkability, walking difficulties, and participation in leisure activities among older people. Methods: Self-reported 2 km walking difficulty (intact, modifications, difficulties) at baseline and participating in organized group, outdoor recreation and cultural activities at baseline and follow-up were studied in community-dwelling persons (N = 848) aged 75-90. A walkability index, calculated using a geographic information system, was categorized into tertiles (lowest, middle, highest). Results: Residence in the highest walkability areas was associated with higher participation in cultural activities and lower participation in outdoor recreation, while the latter was most frequently reported by residents in the lowest walkability areas. Those reporting no difficulties were more likely than those reporting difficulties to participate in all studied activities. Residence in the middle or highest walkability areas predicted higher participation in cultural activities at follow-up. Discussion: Older persons activity profiles associate with neighborhood walkability and walking difficulties.

Associations between walking limitations and reported activity destinations among older adults

In old age, walking difficulty may reduce opportunities to reach valued activity destinations. Walking modifications, e.g., slower pace or using a walking aid, may enable individuals to continue going where they wish, and hence postpone the consequences of the onset of walking difficulties. We studied visited activity destinations (type, distance) among older people with varying degrees of walking limitations. Community-dwelling 75-85-year-old people living in Jyväskylä (N = 901) were asked to state whether they had no difficulty walking 2 km, had modified their walking, or had difficulty walking. On a digital map, participants located physical exercise, attractive, and regular destinations they had visited during the past month. Destination counts and median distance to destinations from home were computed. Participants with intact walking reported higher counts of physical exercise (IRR = 1.45, 95% CI [1.31, 1.61]) and attractive destinations (IRR = 1.23, 95% CI [1.10, 1.40]) than those with walking difficulty and also visited these destinations further away from home than the others (b = 0.46, 95% CI [0.20, 0.71]). Those with walking modifications reported higher counts of physical exercise destinations than those with walking difficulty (IRR = 1.23, 95% CI [1.09, 1.40]). Counts of regular destinations and distance traveled were not associated with walking limitations. Walking modifications may help people with walking difficulty reach destinations further away from home, potentially contributing to their sense of autonomy. For those with walking difficulty, a low count of destinations other than regular destinations, e.g., shops or healthcare facilities, may signal their abandonment of recreational activities and a decrease in their life space, potentially leading to reduced well-being.

Development of the "Social Participation Barriers in Patients With Diabetes" Questionnaire for Older Patients With Diabetes and Evaluation of its Reliability and Validity

Objectives: To develop a questionnaire for evaluating the factors hindering social participation in older patients with diabetes (the Social Participation Barriers in Patients with Diabetes [SPBD] questionnaire) and assess its reliability and validity. Materials and Methods: This is a cross-sectional study. This study included outpatients aged ≥60 years having diabetes and undergoing treatment at the Ise Redcross Hospital. A draft questionnaire consisting of 20 questions was developed with reference to previous studies. Logistic regression analysis was conducted, and Cronbach's alpha coefficient was calculated. Exploratory factor analysis was conducted to test construct validity. Pearson's correlation coefficients between SPBD scores and frailty scores, social frailty scores and frequency of outings were calculated. Results: Overall, 353 patients were included in the analysis. After questions without an association in the logistic regression analysis were excluded and results of the exploratory factor analyses were obtained, 10 questions were excluded. As a result, we created a 10-item SPBD questionnaire. Cronbach's alpha coefficient was .87. The SPBD score was significantly associated with frequency of going out, and frailty. Conclusions: We created an SPBD questionnaire to assess barriers to social participation in older adult patients with diabetes. This study indicated the validity and reliability of the questionnaire.

A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults

OBJECTIVE

To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes.

DATA SOURCES

PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021.

STUDY SECTION

Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted.

DATA EXTRACTION

The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted.

DATA SYNTHESIS

Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors.

CONCLUSIONS

Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.

Association between social capital and health-promoting lifestyle among empty nesters: The mediating role of sense of coherence

To determine the relationship between social capital, sense of coherence, and health-promoting lifestyles of empty nesters and to clarify the mediating role of the sense of coherence. A total of 452 community-based empty nesters were recruited from February 2023 to May 2023 using a convenience sample from Guiyang, China. Cross-sectional data on older adults' social capital, sense of coherence, and health-promoting lifestyle were collected using questionnaires. Structural equation modeling was constructed using Amos 27.0, and the mediating effect of sense of coherence was tested using the bootstrap method. The results showed that the significant mediating role of sense of coherence between social capital and health-promoting lifestyle (β=0.367, SE=0.066, 95% CI [0.246, 0.509]) explained 52.7% of the total effect of social capital on health-promoting lifestyle. These findings provide a better understanding of how social capital and sense of coherence together to affect health-promoting lifestyles, and they could guide the interventions to promote health-promoting lifestyles among empty nesters.

Relationship between person, environmental factors, and activities of daily living performance among physically disabled older adults living at home: a structural equation model

BACKGROUND

Older adults with physical disability need long-term services and support, which incur enormous costs. However, supportive environments may reduce disability and promote aging in place. It is unclear how the physical and social environment affect different types of functional impairments and influence the performance of activities of daily living (ADL) in physically disabled older adults.

OBJECTIVE

The purpose of this study was to examine the relationship between person, environmental factors, and ADL performance among physically disabled older adults living at home.

METHODS

This was a cross-sectional study. Using long-term care insurance claims data from a pilot city in China, we used a structural equation model to assess the potential paths among person, environmental factors, and ADL performance.

RESULTS

Education and income had different influences on the social environment and physical environment. The functional impairments had significant effects on ADL performance, either directly or through physical environment (with handrails) and social environment (family support).

CONCLUSIONS

The present findings offer crucial evidence for understanding the interactions between a person and the environment, as well as their influence on physical ADLs, suggesting the importance of a supportive environment and a subpopulation-targeting strategy for disabled older adults.

Effects of Perceived Discrimination on Behavioral Health Outcomes in People Aging With Traumatic Brain Injury

OBJECTIVE

To evaluate major and everyday experiences of discrimination (MED and EED, respectively) in relation to behavioral health outcomes in people with traumatic brain injury (PwTBI).

SETTING

Outpatient research laboratory.

PARTICIPANTS

Adults, 50 years or older, with a chronic (1+ year) history of moderate or severe TBI ( N = 118).

DESIGN

Cross-sectional observational study.

MAIN MEASURES

MED and EED (primary measures of interest) and behavioral health outcomes: global cognition, psychological symptoms, neurobehavioral symptoms, societal participation, and health-related quality of life (HRQoL). In participants with available geodata ( N = 28), neighborhood socioeconomic deprivation (ND) was examined as a potential contributor to MED, EED, and measured outcomes.

RESULTS

EED and MED were significantly associated with psychological symptoms, neurobehavioral symptoms, and HRQoL after correction for multiple comparisons. Counter to expectations, EED were related to higher societal participation. MED and EED were unrelated to cognition. When MED and EED were entered together in hierarchical regressions, only EED made significant contributions beyond demographic and injury-related covariates to each outcome. Sensitivity analyses revealed that most of these relationships were not solely accounted for by disability-related discrimination. ND showed negligible associations with discrimination but moderate effect sizes for cognition and participation. Race was not significantly related to discrimination and was not a significant predictor in regression models but was strongly associated with ND.

CONCLUSION

The current data provide preliminary support for perceived discrimination as an important factor in neurobehavioral and psychosocial health, but not cognitive performance, after TBI. These relationships appear to be driven by daily experiences of discriminatory treatment versus single major instances of injustice. Measured outcomes may also reflect socioeconomic challenges and structural discrimination faced by diverse PwTBI, although more work in this area is urgently needed. Multiple sources of marginalization and disenfranchisement and their functional effects should be considered in TBI rehabilitation and outcome monitoring.

Ageing in Context: An Ecological Model to Understand Social Participation Among Indigenous Adults in Chile

The social participation of older adults occupies a central position in international discourse regarding ageing, the ecological model makes it possible to examine and assess the different factors that influence the understanding of what encourages social participation by older adults. This study used the ecological model to analyse how personal, community and environmental factors are related to satisfaction with social participation among Chilean older adults, a majority of whom are indigenous, living in rural areas (n = 800). The results confirmed that satisfaction with social participation was related to personal factors (feelings of depression, functioning into basic activities of daily living (ADL) and autonomy), community factors (perceived social support from social group) and environmental factors (accessibility of physical setting within the village). Our findings confirmed a high level of social participation among indigenous adults, with rural and indigenous surroundings appearing to be a factor that protects and promotes social integration.

Physical multimorbidity, depressive symptoms, and social participation in adults over 50 years of age: findings from the English Longitudinal Study of Ageing

OBJECTIVES

The aim of the current study was to identify specific patterns of physical multimorbidity and examine how these patterns associated with changes in social participation over time.

METHODS

We used latent class analysis to identify clusters of physical multimorbidity in 11,391 older adults. Mixed effects regression models were used to assess associations between physical multimorbidity clusters and changes in social participation over 15 years.

RESULTS

Four clusters of physical multimorbidity were identified. All physical multimorbidity clusters were associated with a reduction in cultural engagement (e.g. visits to theatre, cinema, museums) over time, with the strongest association seen in the complex/multisystem cluster (β = -0.26, 95% CI = -0.38 to -0.15). Similar results emerged for leisure activities. Adjusting for depressive symptoms fully attenuated some associations. All physical multimorbidity clusters were associated with an increase in civic participation over time.

CONCLUSIONS

Physical multimorbidity reduced some aspects of social participation over time, with specific combinations of conditions having increased risk of reductions.

Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2017847.

The association between social activity and physical frailty among community-dwelling older adults in Japan

Background

Physical frailty is associated with social activity. However, the relationship between physical frailty and levels of engagement with other people during social activities remains unclear. Thus, we aimed to clarify the relationship between physical frailty and social activity using a taxonomy of activity levels among community-dwelling older adults in Japan.

Methods

This cross-sectional observational study analyzed data from 12,788 older adults (7001 women, mean age: 73.8 years, standard deviation = 5.9; range: 60–96 years) from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. Physical frailty was assessed using the following components: slow walking speed, muscle weakness, exhaustion, low activity, and weight loss. We asked participants about seven social activities that included social participation and engagement and examined their relationship to physical frailty.

Results

Physical frailty was independently associated with all social activities. Exercise circle activity, which includes a level of social participation, was strongly associated with physical pre-frailty and physical frailty. Results of sub-analyses indicated that the level of social engagement was independently associated with physical frailty in the older group (over 75 years) but not in the younger group (60–74 years).

Conclusions

Our results indicate that the strength of the association between social activity and physical frailty differs by the level of social participation. Given the increasingly high prevalence of physical frailty in Japan and its strong association with numerous adverse health outcomes, the relationship between physical frailty and levels of social participation may assist in developing measures to prevent the incidence and progression of physical frailty.

Interventions addressing functional abilities of older people in rural and remote areas: a scoping review of available evidence based on WHO functional ability domains

Background

The World Health Organization (WHO) encourages healthy ageing strategies to help develop and maintain older people’s functional abilities in five domains: their ability to meet basic needs; learn, grow, and make decisions; be mobile; build and maintain relationships, and contribute to society. This scoping review reports the available evidence-based interventions that have been undertaken with people ≥ 50 years of age in rural and remote areas and the outcomes of those interventions relevant to enhancing functional ability.

Methods

The scoping review was undertaken following the JBI methodology. A literature search was carried out to identify published intervention studies for enhancing functional ability in older people living in rural and remote settings. The databases searched included CINAHL, Scopus, ProQuest Central, PubMed, EBSCOHost, APA PsycInfo, Carin.info, and the European Network for Rural Development Projects and Practice database. Gray literature sources included government reports, websites, policy papers, online newsletters, and studies from a bibliographic hand search of included studies.

Results

Literature published from January 2010 to March 9, 2021 were included for review. A total of 67 studies were identified, including quasi-experimental studies (n = 44), randomized controlled trials (n = 22), and a descriptive study. Five main types of interventions were conducted in rural and remote areas with older people: Community Services, Education and Training, Exercise and Physical Activity, Health Promotion Programmes, and Telehealth. Health Promotion Programmes (n = 28, 41.8%) were the most frequently reported interventions. These focused primarily on improving the ability to meet basic needs. About half (n = 35, 52.2%) of the included studies were linked to the ability to learn, grow, and make decisions, and 40% of studies (n = 27) were relevant to the ability to be mobile. Only a very limited number of intervention studies were geared towards outcomes such as maintaining relationships (n = 6) and contributing to society (n = 3).

Conclusion

Interventions for enhancing functional ability focused primarily on the ability to meet basic needs. We identified the need for health-related interventions in rural and remote areas to consider all five functional ability domains as outcomes, particularly to strengthen the psychosocial wellbeing of older people and enhance their sense of purpose through their contributions to society.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03460-2.

Gender specific cut-off points of age for disability among rural elderly in Anhui Province, China

Objective

The purpose of this study was to determine the optimal cut-off values of age for disability in order to predict the risk of disability for older adults in rural areas.

Methods

WHO Disability Assessment Schedule 2.0 was used to assess disability. The cut-off values of age for disability were obtained by ROC curve analysis.

Results

The cut-off points of age for cognition restriction, mobility restriction, self-care restriction, getting along with people restriction, life activities restriction, and social participation restriction for men were 70.5, 68.5, 72.5, 70.5, 71.5, and 68.5 years old, respectively. The cut-off points of age for cognition disability, mobility restriction, self-care disability, getting along with people disability, life activities disability, and social participation disability for women were 72.5, 71.5, 70.5, 70.5, 71.5, and 71.5 years old, respectively. Over the cut-off values of age was an independent risk factor for disability (P < 0.05).

Conclusion

Presenting first disability symptoms were different between men and women. Preventive efforts to prevent future disability should be different for men and women.

Neighbourhood environmental influences on older adults' physical activities and social participation in Singapore: A photovoice study

Physical activities and social participation have vast health benefits for older adults and are also known to influence each other in everyday lives of older adults. In the quest for healthy ageing in place, it is vital to investigate the role of neighbourhood environmental factors in maintaining and/or initiating physical activities and social participation in older adults. Using the photovoice method, this qualitative research aims to examine how the physical and social neighbourhood environment influences physical activities, social participation, and instances where they occur together among 30 older adults in three Singapore neighbourhoods. A thematic analysis of 820 photographs, their descriptions, and 21 semi-structured individual and group interviews reveals that participants' physical activities and social participation are influenced by neighbourhood features during everyday movements (themes related to walking trips and resting places), and at destination nodes (themes on destinations and events where people often met and/or accessed amenities and services). Environmental qualities grounded in the local context affect older adults' outdoor activities. Physical activities and social participation in older adults may be planned or spontaneous, occurring independently, simultaneously or one after another in supportive neighbourhood environments.

Impact of COVID-19 on mobility and participation of older adults living in Hamilton, Ontario, Canada: a multimethod cohort design protocol

INTRODUCTION

The novel COVID-19 required many countries to impose public health measures that likely impacted the participation and mobility of community-dwelling older adults. This protocol details a multimethod cohort design undertaken to describe short-term and medium-term changes to the mobility and participation of older Canadians living in the community rather than retirement facilities during the COVID-19 pandemic.

METHODS AND ANALYSIS

A longitudinal telephone (or online)-administered survey is being conducted with a random sample of older adults living within 20 km of McMaster University, Hamilton, Ontario, Canada, identified from census dissemination areas. Baseline data collection of community-dwelling older adults aged 65 years and over began in May 2020 with follow-ups at 3, 6, 9 and 12 months. The Late-Life Function and Disability Instrument and global rating of change anchors are the primary outcomes of interest. A subsample of respondents will participate in open-ended, semistructured interviews conducted over the telephone or through video-conference, to explore participants' lived experiences with respect to their mobility and participation during the pandemic. Descriptive statistics and quantitative approaches will be used to determine changes in mobility and social and personal participation, and associated personal and environmental factors. For the interviews, qualitative data will be analysed using descriptive phenomenology.

ETHICS AND DISSEMINATION

Approval was obtained from the Hamilton Integrated Research Ethics Board of McMaster University (2020-10814-GRA). This study may inform the design of programmes that can support community-dwelling older adults during and after the COVID-19 pandemic. Findings will be disseminated through peer-reviewed publications and conferences focused on ageing.

The Effect of Receiving a Diagnosis of Alzheimer's Disease and Related Dementias on Social Relationships of Older Adults

INTRODUCTION

Although early diagnosis has been recognized as a key strategy to improve outcomes of Alzheimer's disease and related dementias (ADRD), the effect of receiving a diagnosis on patients' well-being is not well understood. This study addresses this gap by examining if receiving a dementia diagnosis influences social relationships.

METHODS

Data from the 3 waves (2012, 2014, and 2016) of the Health and Retirement Study were utilized as part of this study. This study examined whether receiving a new diagnosis of ADRD changed subsequent social relationships (social networks, social engagement, and social support). Regression analyses with inverse probability weighting were performed to estimate the impact of receiving a dementia diagnosis on changes in social relationships.

RESULTS

Receiving a new diagnosis of ADRD reduced both informal and formal social engagement. We found no statistically significant impacts of receiving a diagnosis of ADRD on social networks and social support.

CONCLUSIONS

Results suggest that receiving a new diagnosis of ADRD may have unintended impacts on social relationships. Practitioners and policymakers should be aware of these consequences and should identify strategies to alleviate the negative impact of receiving a diagnosis of ADRD and methods to mobilize support networks after receiving a diagnosis.

What predicts how safe people feel in their neighborhoods and does it depend on functional status?

Feeling unsafe in one's neighborhood is related to poor health. Features of the neighborhood environment have been suggested to inform perceptions of neighborhood safety. Yet, the relative contribution of these features (e.g., uneven sidewalks, crime, perceived neighborhood physical disorder) on perceived neighborhood safety, particularly among people with disabilities who may view themselves as more vulnerable, is not well understood. We examined whether sidewalk quality assessed by third party raters, county-level crime rates, and perceived neighborhood disorder would relate to neighborhood safety concerns, and whether functional limitations would exacerbate these links. Using data from the 2012/2014 waves of the Health and Retirement Study (n = 10,653, mean age = 66 years), a national sample of older US adults, we demonstrate that those with and without functional limitations felt less safe in areas with more crime and perceived as more disordered. When considered simultaneously, however, only perceived disorder statistically significantly predicted safety concerns. Living in neighborhoods with better sidewalk quality was statistically significantly related to feeling less safe, but only among those with functional limitations. Sidewalk quality was not statistically significantly related to safety reports among those without functional limitations. To our knowledge, this study is among the first to examine multiple features of the neighborhood environment simultaneously in relation to perceived neighborhood safety. Our findings highlight the relative importance of perceived physical disorder, and that these perceptions relate to safety concerns. Replication of this research is needed to determine the robustness of these patterns, including rich data on pedestrian use and sidewalk proximity to roadways. Community-level interventions that simultaneously target the multifaceted features of the neighborhood environment that shape people's safety reports may be needed to reduce burden of health.

Perceptions of community among suburban and urban-dwelling adults aging in place

Community is important for late-midlife adults, offering a sense of belonging and opportunities for social engagement during the transition to older age. The current study examines perceptions of community and geographical ties among a sample of older adults aging in place. Using data from the Foley Longitudinal Study of Adulthood (FLSA; N = 163; aged 61-64) and a qualitative GIS approach, major themes were categorized and mapped to create a comprehensive picture of how perceptions of community varied among respondents and neighborhoods. Core themes were connections to place, space, people, and relational benefits gained from community involvement. Residents of a suburban enclave more frequently noted connections to people as being important to community, compared to residents in more densely-populated areas. Implications for future research are discussed.

A simulation of allocation of participants engaging in group activities at community salons: Accessibility and self-stigma

Community salons are places where older adults receive preventive healthcare and enjoy recreational activities. In Japan, some older adults are reluctant to attend group activity programs at community salons because they do not want to be seen by their neighbors as being elderly who need support from others, even though those activities are meant to prevent functional decline. The phenomenon can be conceptualized as self-stigma of community salon participation, which is a factor explaining why older adults hesitate to participate and some opt for activities at facilities farther away. This paper proposes an allocation problem (considering both accessibility and self-stigma within a Japanese context), demonstrating that participants go to facilities that are farther away, not just those that are closest. The allocation problem is expected to provide local public health agencies with a normative model to assess participants' current allocation (compared with the solutions) and to simulate how best to facilitate older adults' participation or intergroup contact (between those with and without self-stigma). Solutions to the allocation problem are analyzed regarding activity participation, intergroup contact, and distance from participants' home to allocated facilities. Results from the simulation in a virtual city environment show that there could be a segregation of activity groups between people with and without self-stigma. From a comparison among solutions from different geographical settings of residents and facilities, people without self-stigma are less likely to sacrifice their accessibility to allocated facilities in the case of uneven distribution. On the other hand, a larger number of participants with self-stigma is expected, especially in the case of concentrated residential location. The findings suggest that policymakers should consider both the geographical distribution of residents and facilities, the impact of self-stigma, and intergroup contact when they discuss how the policies for older adults' social participation can best result in greater social benefits.

Are non-face-to-face interactions an effective strategy for maintaining mental and physical health?

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has led to social isolation measures, forcing many people to stay indoors, stop daily outdoor activities, and limit face-to-face social interactions with friends, colleagues, and family. This study aimed to identify if non-face-to-face interaction affects depressive symptoms and frailty in older adults.

METHODS

We included 3834 older adults (age: 71.1 ± 6.9 [mean ± standard deviation] years; range: 60-96 years; 2153 women) from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. Interaction status was assessed using a self-reported questionnaire. Participants were categorized into: "both interactions" (both face-to-face and non-face-to-face interactions), "face-to-face only" (only face-to-face interactions), "non-face-to-face only" (only non-face-to-face interactions), "no interactions" (neither face-to-face nor non-face-to-face interactions) groups. Depressive symptoms and frailty were measured using the 15-item Geriatric Depression Scale and Kihon Checklist, respectively.

RESULTS

Potential confounding factors-adjusted odds ratios for both, face-to-face only and non-face-to-face only groups for developing depressive symptoms were 0.39 (95%CI, 0.26-0.57; p<0.001), 0.56 (95%CI, 0.38-0.84; p=0.004), and 0.51 (95%CI, 0.27-0.96; p=0.038), respectively, and those for development of frailty were 0.44 (95%CI, 0.30-0.65; p<0.001), 0.59 (95%CI, 0.39-0.87; p=0.008), and 0.63 (95%CI, 0.34-1.15; p=0.128), respectively.

CONCLUSIONS

Our findings indicate that non-face-to-face interactions are also important in preventing the deterioration of mental health, which is a concern during the COVID-19 pandemic. However, non-face-to-face interactions alone may not be sufficient to maintain physical health, and it is important to maintain opportunities for face-to-face interaction among older adults, particularly during the COVID-19 pandemic.

How Do Environmental Concerns and Governance Performance Affect Public Environmental Participation: A Case Study of Waste Sorting in Urban China

Environmental pollution threatens public health and has become a social concern in recent years. Despite the conditions for public participation in environmental governance have improved considerably, the level of public engagement in government projects still falls short of expectations. Therefore, this article introduced two key variables, hoping to answer the following research question that how environmental concerns and governance performance affect public environmental participation. Through principal component analysis of the data from the “Survey of Chinese Urban Residents’ Attitudes toward Environmental Protection”, the findings of this article are as follows: First, public environmental concerns have no significant impact on their environmental engagement; second, the improvement of residents’ confidence in the government performance of environmental management reduces their willingness to participate in official projects. The higher the confidence in the government’s performance, the lower the level of public engagement is. Moreover, due to the consideration of self-interest or lack of environmental awareness, those who oppose waste incineration in waste terminal disposal tend to take a non-participatory role in waste sorting programs. Therefore, we suggest that the government have more diverse shareholders in environmental protection, so it should expand public participation through education, publicity, mobilization, and incentives.

Perceived neighborhood cohesion buffers COVID-19 impacts on mental health in a United States sample

Objective

This study examined whether perceived neighborhood cohesion (the extent to which neighbors trust and count on one another) buffers against the mental health effects of the 2020 COVID-19 pandemic.

Methods

The XXX University National COVID-19 and Mental Health Study surveyed US adults (N = 3965; M age = 39 years), measuring depressive symptoms, staying home more during than before the 2020 pandemic, and perceived neighborhood cohesion.

Results

A series of linear regressions indicated that perceiving one's neighborhood as more cohesive was not only associated with fewer depressive symptoms, but also attenuated the relationship between spending more time at home during the pandemic and depressive symptoms. These relationships persisted even after taking into account several individual-level sociodemographic characteristics as well as multiple contextual features, i.e., median household income, population density, and racial/ethnic diversity of the zip codes in which participants resided.

Conclusions

Neighborhood cohesion may be leveraged to mitigate pandemic impacts on depressive symptoms.

Formal and informal social participation and elder mistreatment in a national sample of older adults

BACKGROUND/OBJECTIVES

Older adults' susceptibility to mistreatment may be affected by their participation in social activities, but little is known about relationships between social participation and elder mistreatment.

DESIGN

Cross-sectional analysis.

SETTING/PARTICIPANTS

National probability sample of older community-dwelling U.S. adults interviewed in 2015-2016, including 1268 women and 973 men (mean age 75 years and 76 years, respectively; 82% non-Hispanic white).

MEASUREMENTS

Frequency of participation in formal activities (organized meetings, religious services, and volunteering) and informal social activities (visiting friends and family) was assessed by questionnaire. Elder mistreatment included emotional (four items), physical (two items), and financial mistreatment (two items) since age 60. Multivariable logistic regression examined associations between each type of social participation and elder mistreatment among men and women, adjusting for age, race/ethnicity, education, and comorbidity.

RESULTS

Forty percent of women and 22% of men reported at least one form of mistreatment (emotional, physical, or financial). Women reporting at least monthly engagement in formal social activities were more likely to report emotional mistreatment (adjusted odds ratio (AOR) 1.59, 95% confidence interval (CI) 1.09-2.33). Among men, monthly organized meeting attendance was associated with increased odds of emotional mistreatment (AOR 1.34, 95% CI 1.01-1.93). Weekly informal socializing was inversely associated with emotional mistreatment (AOR 0.59, 95% CI 0.44-0.78) and financial mistreatment (AOR 0.59, 95% CI 0.42-0.85) among women.

CONCLUSION

In this national cohort, older adults who were frequently engaged in formal social activities reported similar or higher levels of mistreatment than those with less frequent organized social participation. Older women with regular informal contact with family or friends were less likely to report some kinds of mistreatment. Strategies for detecting and mitigating elder mistreatment should consider differences in patterns of formal and informal social participation and their potential contribution to mistreatment risk.

Neighborhood environmental attributes and walking mobility decline: A longitudinal ecological study of mid-to-older aged Australian adults

OBJECTIVES

Cross-sectional studies have found some built environmental attributes to be associated with residents' lower levels of mobility (functional capacity to walk outside the home). However, less is known about what environmental attributes are related to mobility decline. This longitudinal study examined area-level associations of specific environmental attributes with mid-to-older aged adults' changes in walking mobility.

METHODS

Data collected from 4,088 adults (aged 46-71 years at baseline) who participated in a cohort study in Brisbane, Australia were used. The outcome was the change in self-reported mobility score (SF-36) from 2013 to 2016, which were aggregated at the neighborhood (N = 156) and suburb (N = 99) levels, due to the known lack of sensitivity in SF-36 subscales to individual changes. Linear regression analysis examined associations of mobility change with seven environmental attributes measured at baseline (residential density, intersection density, land use mix, density of walking/bike paths, park density, bus stop density, density of social incivilities), adjusting for confounding variables.

RESULTS

Participants on average reported 4% of mobility decline during the 3-year study period. It was found that greater land use diversity was consistently associated with less decline in walking mobility, while greater density of social incivilities was associated with more decline in walking mobility. The latter finding was significant only at the neighborhood level. No consistent associations were observed for residential density, intersection density, density of walking/bike paths, park density, and bus stop density.

DISCUSSION

Our findings suggest that mid-to-older aged adults who live in areas with lower land use diversity and more social incivilities may be at risk of developing mobility limitations. Recommended policies to slow residents' mobility decline and to achieve aging in place include improving these environmental attributes where needed and advising older adults to relocate to safer, mixed-use neighborhoods.

Investigating Factors of Active Aging among Chinese Older Adults: A Machine Learning Approach

BACKGROUND AND OBJECTIVES

With the extension of healthy life expectancy, promoting active aging has become a policy response to rapid population aging in China. Yet, it has been inconclusive about the relative importance of the determinants of active aging. By applying a machine learning approach, this study aims to identify the most important determinants of active aging in three domains, i.e., paid/unpaid work, caregiving, and social activities, among Chinese older adults.

RESEARCH DESIGN AND METHOD

Data were drawn from the first wave of the China Health and Retirement Longitudinal Study (CHARLS), which surveys a nationally representative sample of adults aged 60-year-old and above (N=7,503). We estimated Random Forest and the least absolute shrinkage and selection operator (LASSO) regression models to determine the most important factors related to active aging.

RESULTS

Health has a generic effect on all outcomes of active aging. Our findings also identified the domain-specific determinants of active aging. Urban/rural residency is among the most important factors determining the likelihood of engaging in paid/unpaid work. Living in a multi-generational household is especially important in predicting caregiving activities. Neighborhood infrastructure and facilities have the strongest influence on older adults' participation in social activities.

DISCUSSION AND IMPLICATIONS

The application of feature selection models provides a fruitful first step in identifying the most important determinants of active aging among Chinese older adults. These results provide evidence-based recommendations for policies and practices promoting active aging.

Social and physical neighbourhood characteristics and loneliness among older adults: results from the MINDMAP project

BACKGROUND

Loneliness is associated with several adverse mental and physical health outcomes in older adults. Previous studies have shown that a variety of individual-level and perceived area-level characteristics are associated with loneliness. This study examined the associations of objectively measured social and physical neighbourhood characteristics with loneliness.

METHODS

We used cross-sectional data from 1959 older adults (63-98 years) who participated in the Longitudinal Ageing Study Amsterdam (LASA; wave 2011/12) and the Health and Living Conditions of the Population of Eindhoven and Surroundings study (GLOBE; wave 2014) in the Netherlands. Study-specific loneliness scores were harmonised across both cohort studies and divided into tertiles denoting low, medium and high levels of loneliness. Objectively measured neighbourhood characteristics, including area-level percentages of low educated residents, social security beneficiaries and unoccupied dwellings, average income, crime levels and land use mix, were linked to individual-level data. Multinomial logistic regression analyses were conducted to examine the associations of interest.

RESULTS

There was no statistical evidence for an association of the included neighbourhood characteristics with loneliness. Although not statistically significant, the observed associations suggested that participants living in neighbourhoods with more heterogeneous land use mix were less likely to have a medium and high level of loneliness than those living in more homogeneous neighbourhoods in terms of land use mix (ORmedium=0.54, 95% CI=0.18-1.67; ORhigh=0.67, 95% CI=0.21-2.11).

CONCLUSION

The results indicate that the included objectively measured social and physical neighbourhood characteristics are not associated with loneliness in old age.

Depressive Symptoms among Rural "Left-Behind" Older Adults: A Test of the High Outmigration Penalty Hypothesis

OBJECTIVES

We investigated whether there was a "high outmigration penalty" for psychological health among older adults in rural China by assessing two potential community stressors associated with major sociodemographic changes in the community - increased outmigration and older adult density. We also investigated whether disparities in community economic conditions moderated the association between community stressors and depressive symptoms.

METHODS

We employed three waves of data from the China Health and Retirement Longitudinal Study (2011-2015), using multilevel negative binomial models to address our research questions.

RESULTS

Our results supported the "high outmigration penalty" hypothesis. Older adults living in low-income rural communities may experience an aggravated mental health penalty compared to those living in high-income rural communities. Higher older adult density was also associated with more depressive symptoms but only in less wealthy communities. Community differences in economic conditions were key factors buffering the high outmigration disadvantage associated with the psychological health of older Chinese adults.

DISCUSSION

Rural outmigration may have deepened existing inter-community health disparities among older adults. Policies should be developed to address community-level factors negatively associated with the well-being of older Chinese adults living in high outmigration and less wealthy rural communities.

Regeneration of deprived neighbourhoods and indicators of functioning in older adults: A quasi-experimental evaluation of the Dutch District Approach

This study examines the impact of the Dutch District Approach, a major urban regeneration programme that was started in 2008 in the Netherlands, on social, physical and mental functioning of older adults. Data from 1092 participants (58-93 years at baseline) across two waves (2005/06 and 2011/12) of the Longitudinal Aging Study Amsterdam were linked to detailed data on exposure to the programme. Using a difference-in-difference approach, we assessed differences from pre-intervention to the intervention period between the target and control districts in loneliness, social engagement, social isolation, physical activity, and anxiety and depressive symptoms. Regardless of programme intensity, the results indicate that the Dutch District Approach did not benefit or harm these aspects of functioning in older adults.

Influence of activity space on the association between neighborhood characteristics and dementia risk: results from the 3-City study cohort

Background

Socioeconomic level of residential environment was found to influence cognitive performance. However, individuals from the same place of residence may be affected differently. We aim to investigate for the first time the influence of individual activity space on the association between neighborhood socioeconomic status (NSES) and the risk of dementia.

Methods

In the frame of the Three-City cohort, a French population-based study, we followed longitudinally (12 years) 7009 participants aged over 65. The activity space (i.e., the spatial area through which a person moves daily) was defined using two questions from Lawton’s Instrumental Activities of Daily Living scale (“Goes shopping independently”,“Travels alone”), and one question about mobility restriction. The survival analysis was performed using a Cox marginal model that takes into account intra-neighborhood correlations and includes a large number of potential confounders.

Results

Among people with a limited activity space (n = 772, 11%), risk of dementia is increased in subjects living in a deprived area (characterized by high GINI index or low median income) compared to those living in more favored.

Conclusion

This study shows that the individual activity space modifies the association between NSES and the risk of dementia providing a more complete picture of residential inequalities. If confirmed in different populations, these findings suggest that people with limited activity space and living in a deprived neighborhood are particularly at risk and should be targeted for prevention.

Productive aging via volunteering: Does social cohesion influence level of engagement?

This study investigated whether neighborhood social cohesion influenced volunteer intensity over two years. The sample was drawn from Health and Retirement Study respondents who completed the 2010 or 2012 Psychosocial and Lifestyle Questionnaire (n = 12,929). Results showed that compared to nonvolunteers, a one-unit increase in neighborhood social cohesion increased the odds of moderate (OR: 1.07, p < .05) and high volunteering (OR: 1.10, p < .001). However, other productive roles, social contact, and education were significant in distinguishing high intensity from moderate volunteering while neighborhood social cohesion was not. Social workers should consider the neighborhood environment when recruiting volunteers.

Evaluating Disparities in Elderly Community Care Resources: Using a Geographic Accessibility and Inequality Index

This study evaluated geographic accessibility and utilized assessment indices to investigate disparities in elderly community care resource distribution. The data were derived from Taiwanese governmental data in 2017, including 3,148,283 elderly individuals (age 65+), 7681 villages, and 1941 community care centers. To identify disparities in geographic accessibility, we compared the efficacy of six measurements and proposed a composite index to identify levels of resource inequality from the Gini coefficient and “median-mean” skewness. Low village-level correlation (0.038) indicated inconsistencies between the demand populations and community care center distribution. Method M6 (calculated accessibility of nearest distance-decay accounting for population of villages, supplier loading, and elderly walkability) was identified as the most comprehensive disparity measurement. Community care policy assessment requires a comprehensive and weighted calculation process, including the elderly walkability distance-decay factor, demand population, and supplier loading. Three steps were suggested for elderly policy planning and improvement in future.

Cross-sectional associations of objectively assessed neighbourhood attributes with depressive symptoms in older adults of an ultra-dense urban environment: the Hong Kong ALECS study

OBJECTIVES

This study aimed to examine the associations between objectively assessed neighbourhood environmental attributes and depressive symptoms in Hong Kong Chinese older adults and the moderating effects of neighbourhood environmental attributes on the associations between living arrangements and depressive symptoms.

DESIGN

Cross-sectional observational study.

SETTING

Hong Kong.

PARTICIPANTS

909 Hong Kong Chinese community dwellers aged 65+ years residing in preselected areas stratified by walkability and socioeconomic status.

EXPOSURE AND OUTCOME MEASURES

Attributes of participants' neighbourhood environment were objectively assessed using geographic information systems and environmental audits. Depressive symptoms were measured using the Geriatric Depression Scale.

RESULTS

Overall, pedestrian infrastructure (OR=1.025; P=0.008), connectivity (OR=1.039; P=0.002) and prevalence of public transport stops (OR=1.056; P=0.012) were positively associated with the odds of reporting depressive symptoms. Older adults living alone were at higher risk of reporting any depressive symptoms than those living with others (OR=1.497; P=0.039). This association was moderated by neighbourhood crowdedness, perceptible pollution, access to destinations and presence of people. Residing in neighbourhoods with lower levels of these attributes was associated with increased deleterious effects of living alone. Living in neighbourhoods with lower public transport density also increased the deleterious effects of living alone on the number of depressive symptoms. Those living alone and residing in neighbourhoods with higher levels of connectivity tended to report more depressive symptoms than their counterparts.

CONCLUSIONS

The level of access to destinations and social networks across Hong Kong may be sufficiently high to reduce the risk of depressive symptoms in older adults. Yet, exposure to extreme levels of public transport density and associated traffic volumes may increase the risk of depressive symptoms. The provision of good access to a variety of destinations, public transport and public open spaces for socialising in the neighbourhood may help reduce the risk of depressive symptoms in older adults who live alone.