Cognition in Context: The Role of Objective and Subjective Measures of Neighborhood and Household in Cognitive Functioning in Later Life

Household Environments and Functional Decline Among Middle-Aged and Older Adults in China: Variations by Gender, Age, and Residence

This study examined the associations between household social, economic, and physical environments and the trajectory of functional limitations over time among middle-aged and older adults in China, and how this relationship differs by gender, age, and residence. Linear growth curve models were applied to a sample of 13,564 respondents aged 45 years and older from four waves of the China Health and Retirement Longitudinal Study (CHARLS 2011-2018). Living alone, particularly for rural, female, and older respondents, was associated with a faster functional decline when compared to living with a spouse and without children. Improved housing quality was associated with a slower functional decline. Living with young descendants and without adult children for urban residents and a lower expenditure per capita for younger respondents were associated with a faster functional decline. These findings suggest that policies aimed at enhancing living conditions have the potential to improve physical functioning of older adults.

An exploration of neighborhood characteristics, psychosocial resilience resources, and cognitive functioning among midlife and older black adults

OBJECTIVES

While existing research has shown that Black adults have worse cognitive functioning than their White counterparts, the psychosocial correlates of cognitive functioning for Black older adults are understudied. The objective of this study was to investigate the relationships among perceived neighborhood characteristics, psychosocial resilience resources, and cognitive functioning among midlife and older Black adults.

METHODS

Data were from 3,191 Black adults ages 51+ in the 2008-2016 waves of the Health and Retirement Study to examine associations among neighborhood characteristics, psychosocial resilience (sense of purpose, mastery, and social support), and cognitive functioning among Black adults. Multilevel linear regression models assessed direct effects of neighborhood characteristics and psychosocial resources on cognitive functioning. We then tested whether psychosocial resources moderated the association between neighborhood characteristics and cognitive functioning.

RESULTS

Mean levels of cognitive functioning, sense of purpose, social support, and mastery were significantly related to neighborhood disorder and discohesion. Regression results showed that levels of neighborhood disorder and high discohesion were significantly associated with cognitive functioning. Sense of purpose was positively associated with cognitive functioning, net of neighborhood characteristics. However, only social support moderated the association between neighborhood discohesion and cognition.

CONCLUSIONS

These findings demonstrate the importance of examining psychosocial and contextual risk and resilience resources among midlife and older Black adults. This work may inform the development of cognitive behavioral interventions aimed at increasing sense of purpose to promote and enhance cognitive resiliency among Black adults. Altogether, this work may have implications for policy aimed at advancing cognitive health equity.

Perceived but not objective measures of neighborhood safety and food environments are associated with longitudinal changes in processing speed among urban older adults

BACKGROUND

Although a growing body of literature documents the importance of neighborhood effects on late-life cognition, little is known about the relative strength of objective and subjective neighborhood measures on late-life cognitive changes. This study examined effects of objective and subjective neighborhood measures in three neighborhood domains (neighborhood safety, physical disorder, food environments) on longitudinal changes in processing speed, an early marker of cognitive aging and impairment.

METHODS

The analysis sample included 306 community-dwelling older adults enrolled in the Einstein Aging Study (mean age = 77, age range = 70 to 91; female = 67.7%; non-Hispanic White: 45.1%, non-Hispanic Black: 40.9%). Objective and subjective measures of neighborhood included three neighborhood domains (i.e., neighborhood safety, physical disorder, food environments). Processing speed was assessed using a brief Symbol Match task (unit: second), administered on a smartphone device six times a day for 16 days and repeated annually for up to five years. Years from baseline was used as the within-person time index.

RESULTS

Results from mixed effects models showed that subjective neighborhood safety (β= -0.028) and subjective availability of healthy foods (β= -0.028) were significantly associated with less cognitive slowing over time. When objective and subjective neighborhood measures were simultaneously examined, subjective availability of healthy foods remained significant (β= -0.028) after controlling for objective availability of healthy foods. Associations of objective neighborhood crime and physical disorder with processing speed seemed to be confounded by individual-level race and socioeconomic status; after controlling for these confounders, none of objective neighborhood measures showed significant associations with processing speed.

CONCLUSION

Subjective neighborhood safety and subjective availability of healthy foods, rather than objective measures, were associated with less cognitive slowing over time over a five-year period. Perception of one's neighborhood may be a more proximal predictor of cognitive health outcomes as it may reflect one's experiences in the environment. It would be important to improve our understanding of both objective and subjective neighborhood factors to improve cognitive health among older adults.

Household Environments and Cognitive Decline Among Middle-Aged and Older Adults in China: Exploring Gender, Age, and Residential Variations

This study examined the relationship between household environments and trajectories of cognitive function among middle-aged and older adults in China and its urban/rural, gender, and age variations. We estimated multi-level linear growth curve models using a representative sample of 16,111 respondents aged 45 years and over from the China Health and Retirement Longitudinal Study (2011-2018). Older people who lived with a spouse, but not with children, and those with higher living expenditures, better housing quality, and indoor clean fuels for cooking had a slower cognitive decline. Living arrangement more strongly predicted men's cognitive decline, while living expenditure, solid fuel use, and housing quality significantly predicted only women's cognitive decline. Only for older adults and rural residents, those living alone had significantly faster cognitive decline than those living with a spouse only. These findings underscore the importance of improving the living conditions of older adults to help alleviate their cognitive decline.

Determinants of sedentary behavior in community-dwelling older adults with type 2 diabetes based on the behavioral change wheel: a path analysis

BACKGROUND

Sedentary behavior (SB) is deeply ingrained in the daily lives of community-dwelling older adults with type 2 diabetes mellitus (T2DM). However, the specific underlying mechanisms of the determinants associated with SB remain elusive. We aimed to explore the determinants of SB based on the behavior change wheel framework as well as a literature review.

METHODS

This cross-sectional study recruited 489 community-dwelling older adults with T2DM in Jinan City, Shandong Province, China. Convenience sampling was used to select participants from relevant communities. This study used the Measure of Older Adults' Sedentary Time-T2DM, the Abbreviated-Neighborhood Environment Walkability Scale, the Social Support Rating Scale, the Lubben Social Network Scale 6, the Subjective Social Norms Questionnaire for Sedentary Behavior, the Functional Activities Questionnaire, the Numerical Rating Scale, the Short Physical Performance Battery, and the Montreal Cognitive Assessment Text to assess the levels of and the determinants of SB. Descriptive statistical analysis and path analysis were conducted to analyze and interpret the data.

RESULTS

Pain, cognitive function, social isolation, and social support had direct and indirect effects on SB in community-dwelling older adults with T2DM (total effects: β = 0.426, β = -0.171, β = -0.209, and β = -0.128, respectively), and physical function, walking environment, and social function had direct effects on patients' SB (total effects: β = -0.180, β = -0.163, and β = 0.127, respectively). All the above pathways were statistically significant (P < 0.05). The path analysis showed that the model had acceptable fit indices: RMSEA = 0.014, χ 2/df = 1.100, GFI = 0.999, AGFI = 0.980, NFI = 0.997, RFI = 0.954, IFI = 1.000, TLI = 0.996, CFI = 1.000.

CONCLUSION

Capability (physical function, pain, and cognitive function), opportunity (social isolation, walking environment, and social support), and motivation (social function) were effective predictors of SB in community-dwelling older adults with T2DM. Deeper knowledge regarding these associations may help healthcare providers design targeted intervention strategies to decrease levels of SB in this specific population.

Cross-sectional associations between neighborhood characteristics, cognition and dementia risk factor burden in middle-aged and older Australians

Dementia disproportionately affects individuals from disadvantaged backgrounds, including those living in areas of lower neighborhood-level socioeconomic status. It is important to understand whether there are specific neighborhood characteristics associated with dementia risk factors and cognition which may inform dementia risk reduction interventions. We sought to examine whether greenspace, walkability, and crime associated with the cumulative burden of modifiable dementia risk factors and cognition. This was a cross-sectional analysis of 2016-2020 data from the Healthy Brain Project, a population-based cohort of community-dwelling individuals across Australia. Participants were aged 40-70 and free of dementia. Measures included greenspace (greenspace % in the local area, and distance to greenspace, n = 2,181); and intersection density (n = 1,159), and crime (rate of recorded offences; n = 1,159). Outcomes included a modified Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) dementia risk score to index the burden of modifiable vascular dementia risk factors; and composite scores of both memory and attention, derived from the Cogstate Brief Battery. Linear regressions adjusted for age, sex, education, and personal socio-economic status, demonstrated distance to greenspace (b ± SE per 2-fold increase = 0.09 ± 0.03, p =.005) and crime rate (b ± SE per 2-fold increase = 0.07 ± 0.03, p =.018) were associated with higher modified CAIDE. Higher crime was associated with lower memory performance (b ± SE = -0.03 ± 0.01, p =.018). The association between distance to greenspace and modified CAIDE was only present in low-moderate socioeconomic status neighborhoods (p interaction = 0.004). Dementia prevention programs that address modifiable risk factors in midlife should consider the possible role of neighborhood characteristics.

Exposure to neighborhood violence, and laboratory-based and ambulatory cognitive task performance in adulthood

OBJECTIVE

Exposure to neighborhood violence may have negative implications for adults' cognitive functioning, but the ecological sensitivity of these effects has yet to be determined. We first evaluated the link between exposure to neighborhood violence and two latent constructs of cognitive function that incorporated laboratory-based and ambulatory, smartphone-based, cognitive assessments. Second, we examined whether the effect of exposure to violence was stronger for ambulatory assessments compared to in-lab assessments.

METHODS

We used data from 256 urban-dwelling adults between 25 and 65 years old (M = 46.26, SD = 11.07); 63.18% non-Hispanic Black, 9.21% non-Hispanic White, 18.41% Hispanic White, 5.02% Hispanic Black, and 4.18% other. Participants completed baseline surveys on neighborhood exposures, cognitive assessments in a laboratory/research office, and ambulatory smartphone-based cognitive assessments five-times a day for 14 days.

RESULTS

Exposure to neighborhood violence was associated with poorer performance in a latent working memory construct that incorporated in-lab and ambulatory assessments, but was not associated with the perceptual speed construct. The effect of exposure to neighborhood violence on the working memory construct was explained by its effect on the ambulatory working memory task and not by the in-lab cognitive assessments.

CONCLUSION

This study shows the negative effect that exposure to neighborhood violence may have on everyday working memory performance in urban-dwelling adults in midlife. Results highlight the need for more research to determine the sensitivity of ambulatory assessments to quantify the effects of neighborhood violence on cognitive function.

A Scoping Review of Neighborhoods and Cognitive Health Disparities Among US Midlife and Older Adults

Objectives: The neighborhood environment may be an important determinant of racial/ethnic disparities in cognitive function. To understand how neighborhoods are linked to cognition across racial/ethnic groups, this scoping review organizes research investigating relationships between multiple neighborhood domains and cognitive function in diverse samples of US midlife and older adults. Methods: PubMed/MEDLINE, Web of Science, and CAHL were used to extract quantitative disparities-focused studies (n = 17) that included US adults ages 50+, racial/ethnic minoritized populations, cognitive dependent variable(s), and neighborhood-level independent variable(s) published from January 2010 to October 2021. Results: Studies demonstrate variation within and between racial/ethnic groups in how neighborhood factors are associated with cognition. Economically and socially advantaged neighborhoods were associated with better cognition. Findings were mixed for built and neighborhood composition measures. Discussion: More research with greater racial/ethnic representation is needed to disentangle which aspects of the neighborhood are most salient for specific cognitive function domains across diverse populations.

Effects of neighborhood built environment on cognitive function in older adults: a systematic review

BACKGROUND

In the background of an aging population, the risk of cognitive impairment in the older population is prominent. Exposure to complex neighborhood built environments may be beneficial to the cognitive health of older adults, and the purpose of this study was to systematically review the scientific evidence on the effects of neighborhood built environments on cognitive function in older adults.

METHODS

Keywords and references were searched in Web of Science, Pubmed, PsycINFO, and MEDLINE. Studies examining the relationship between the built environment and cognitive function in older adults were included. The neighborhood built environment as an independent variable was classified according to seven aspects: density, design, diversity, destination accessibility, public transportation distance, blue/green space, and built environment quality. The cognitive function as the dependent variable was classified according to overall cognitive function, domain-specific cognitive function, and incidence of dementia. The quality of the included literature was assessed using the National Institutes of Health's Observational Cohort and Cross-Sectional Study Quality Assessment Tool.

RESULTS

A total of 56 studies were included that met the inclusion criteria, including 31 cross-sectional studies, 23 longitudinal studies, 1 cross-sectional study design combined with a case-control design, and 1 longitudinal study design combined with a case-control design. Most of the studies reviewed indicate that the built environment factors that were positively associated with cognitive function in older adults were population density, street connectivity, walkability, number of public transportation stops around the residence, land use mix, neighborhood resources, green space, and quality of the neighborhood built environment. Built environment factors that were negatively associated with cognitive function in older adults were street integration, distance from residence to main road. The relationship between residential density, destination accessibility, and blue space with cognitive function in older adults needs to be further explored.

CONCLUSION

Preliminary evidence suggests an association between the neighborhood built environment and cognitive function in older adults. The causal relationship between the built environment and cognitive function can be further explored in the future using standardized and combined subjective and objective assessment methods, and longitudinal or quasi-experimental study designs. For public health interventions on the cognitive health of older adults, it is recommended that relevant authorities include the neighborhood built environment in their intervention programs.

Social Disconnectedness, Perceived Loneliness, and Cognitive Functioning: The Role of Neighborhood Environment

Background and Objectives

Social disconnectedness and loneliness pose significant challenges for older Chinese immigrants. Yet, it remains unclear whether they are associated with an increased risk of cognitive decline in this population. This study aimed to investigate the association of social disconnectedness and loneliness with cognitive functioning and examine the moderation role of neighborhood contexts.

Research Design and Methods

This longitudinal analysis examined a sample of individuals aged 60 years and older from the Population Study of Chinese Elderly in Chicago (N = 2,044). Global cognition was assessed using the averaged z-scores of cognitive performance tests. Social disconnectedness was constructed using 5 indicators about structural aspects of social relationships. Loneliness was assessed with the R-UCLA loneliness scale. Neighborhood socioeconomic status (NSES) and neighborhood segregation index were constructed using 2010-2014 American Community Survey data at the census tract level. Individual perceptions about neighborhood environments were used to construct neighborhood cohesion index and neighborhood disorder index (NDI). Latent growth curve models with adjusted cluster robust standard errors were estimated.

Results

More loneliness was associated with a higher level of initial cognitive functioning (B = 0.030, p < .01), but also with a faster decline rate over time (B = -0.007, p < .01) after adjusting for covariates. High NSES and less neighborhood segregation buffered the negative effects of loneliness on cognitive decline, respectively. High NDI amplified the positive relationship between loneliness and initial functioning, but accelerated the rate of cognitive decline associated with loneliness.

Discussion and Implications

The study revealed that perceived loneliness, but not social disconnectedness, is a risk factor for cognitive decline among older Chinese immigrants. Living in a neighborhood with low socioeconomic status, more segregation, and high disorder elevated the detrimental effect of loneliness on long-term cognitive decline. Further research needs to investigate the complex interplay between social relationships, neighborhood environment, and cognition.

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

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

Cumulative exposure to extreme heat and trajectories of cognitive decline among older adults in the USA

BACKGROUND

The projected increase in extreme heat days is a growing public health concern. While exposure to extreme heat has been shown to negatively affect mortality and physical health, very little is known about its long-term consequences for late-life cognitive function. We examined whether extreme heat exposure is associated with cognitive decline among older adults and whether this association differs by race/ethnicity and neighbourhood socioeconomic status.

METHODS

Data were drawn from seven waves of the Health and Retirement Study (2006-2018) merged with historical temperature data. We used growth curve models to assess the role of extreme heat exposure on trajectories of cognitive function among US adults aged 52 years and older.

RESULTS

We found that high exposure to extreme heat was associated with faster cognitive decline for blacks and residents of poor neighbourhoods, but not for whites, Hispanics or residents of wealthier neighbourhoods.

CONCLUSION

Extreme heat exposure can disproportionately undermine cognitive health in later life for socially vulnerable populations. Our findings underscore the need for policy actions to identify and support high-risk communities for increasingly warming temperatures.

Implications of Aging in Place in the Context of the Residential Environment: Bibliometric Analysis and Literature Review

The residential environment's impact on aging in place is a multidisciplinary field that draws from architecture, urban planning, gerontology, psychology, and sociology. This multidisciplinary nature makes it challenging to comprehensively understand the field and identify the connections and interactions among disciplines. A bibliometric analysis is crucial for exploring the field's intellectual structure, identifying interdisciplinary collaborations, and tracking the knowledge flow across disciplines and will facilitate cross-disciplinary dialogue, foster collaboration, and encourage research that integrates diverse perspectives. This study reviewed the literature on aging in place in the context of a residential environment, which required adapting theories and methodologies. It analyzed a dataset of 1500 publications retrieved from the Web of Science, applied performance analysis techniques, and utilized VOSviewer to visualize the intellectual structure and evolving research themes. The results emphasize the increasing strength of academic interest and the growing diversity of fields related to the topic. The findings are discussed in terms of productivity, collaboration, and research themes from the past to the future. The results provide a roadmap for researchers, policymakers, and practitioners worldwide who focus on aging in place and acknowledge the importance of considering the physical, social, and cultural aspects of an older adult's living environment.

Neighborhood Cohesion Across the Life Course and Effects on Cognitive Aging

OBJECTIVES

Greater neighborhood cohesion is associated with better cognitive function in adulthood and may serve as a protective factor against cognitive impairment and decline. We build on prior work by examining the effects of perceived neighborhood cohesion across the life course on level and change in cognitive function in adulthood.

METHODS

Utilizing longitudinal data from the Health and Retirement Study (1998-2016) and its Life History Mail Survey, we leveraged data from 3,599 study participants (baseline age: 51-89) who participated in up to 10 waves. Respondents provided retrospective ratings of neighborhood cohesion at childhood (age 10), young adulthood (age at the first full-time job), early midlife (age 40), and concurrently at baseline (i.e., late midlife/adulthood); they completed the modified version of the Telephone Interview for Cognitive Status. We fit a univariate latent growth curve model of change in cognitive function across waves and tested whether neighborhood cohesion during each recollected life stage predicted level and change in cognitive function.

RESULTS

Greater neighborhood cohesion during childhood and late midlife/adulthood each predicted higher cognitive function at baseline but not the rate of cognitive decline. The final model showed that greater neighborhood cohesion in childhood and in late midlife/adulthood remained significantly associated with higher baseline cognitive function, even after accounting for one another.

DISCUSSION

Findings provide insight into life-course neighborhood contextual influences on cognitive aging. Our results emphasize the need for more research to understand the life-course dynamics between neighborhood environments and cognitive aging.

Association of Perceived Neighborhood Environments With Cognitive Function in Older Adults

The current study examined the associations between perceptions of the social and physical neighborhood environments and cognitive function in older adults. This cross-sectional study analyzed 821 adults aged ≥65 years from the Adult Changes in Thought study. Perceived neighborhood attributes were measured by the Physical Activity Neighborhood Environment Scale. Cognitive function was assessed using the Cognitive Ability Screening Instrument. The associations were tested using multivariate linear regression. One point greater perceived access to public transit was associated with 0.56 points greater cognitive function score (95% confidence interval [CI] [0.25, 0.88]), and an additional one point of perceived sidewalk coverage was related to 0.22 points higher cognitive function score (95% CI [0.00, 0.45]) after controlling for sociodemographic factors. The perception of neighborhood attributes alongside physical infrastructure may play an important role in supporting older adults' cognitive function. [Journal of Gerontological Nursing, 49(8), 35-41.].

Living Alone, Environmental Hazards, and Falls Among U.S. Older Adults

Background and Objectives

Physical conditions of living environments can affect the incidence of falls; however, prior work has focused typically on 1 domain at a time-either neighborhood or home, capturing limited environmental boundaries of older adults. We examined how neighborhood together with the home environment affect the incidence of falls over time and whether living arrangement modifies the influence of the environmental risks on falls.

Research Design and Methods

Using the 2012-2020 waves of the Health and Retirement Study (HRS; N = 1,893), we fitted logistic regression to estimate the incidence of falls over an 8-year study period. We used the neighborhood and housing data that are collected systematically by trained observers in the HRS to assess environmental hazards. Sidewalk quality, neighborhood disorder, and the presence of green space were measured to capture outdoor environmental hazards. Indoor environmental hazards included the presence of housing decay and poorly maintained stairways. All models were stratified by living arrangement.

Results

Neighborhood and housing environment were independently associated with the odds of falls net of demographic characteristics and preexisting health conditions, and effects were significant for people living alone only. The presence of green space and poorly maintained stairways were associated with greater odds of falling, net of covariates during 8 years of follow-up (odds ratios = 2.10 and 2.65, p < .05, respectively). None of the environmental risk factors were significant for those living with others.

Discussion and Implications

Falls in old age may be determined in part by a combination of outdoor and indoor risk factors. More research is needed to understand pathways that lead to greater vulnerability among older adults living alone to environmental hazards.

Functional social support and cognitive function in middle- and older-aged adults: a systematic review of cross-sectional and cohort studies

BACKGROUND

Intact cognitive function is crucial for healthy aging. Functional social support is thought to protect against cognitive decline. We conducted a systematic review to investigate the association between functional social support and cognitive function in middle- and older-aged adults.

METHODS

Articles were obtained from PubMed, PsycINFO, Sociological Abstracts, CINAHL, and Scopus. Eligible articles considered any form of functional social support and cognitive outcome. We narratively synthesized extracted data by following the Synthesis Without Meta-Analysis (SWiM) guidelines and assessed risk of bias using the Newcastle-Ottawa Scale (NOS).

RESULTS

Eighty-five articles with mostly low risk-of-bias were included in the review. In general, functional social support-particularly overall and emotional support-was associated with higher cognitive function in middle- and older-aged adults. However, these associations were not all statistically significant. Substantial heterogeneity existed in the types of exposures and outcomes evaluated in the articles, as well as in the specific tools used to measure exposures and outcomes.

CONCLUSIONS

Our review highlights the role of functional social support in the preservation of healthy cognition in aging populations. This finding underscores the importance of maintaining substantive social connections in middle and later life.

SYSTEMATIC REVIEW REGISTRATION

Rutter EC, Tyas SL, Maxwell CJ, Law J, O'Connell ME, Konnert CA, Oremus M. Association between functional social support and cognitive function in middle-aged and older adults: a protocol for a systematic review. BMJ Open;10(4):e037301. https://doi.org/10.1136/bmjopen-2020-037301.

Self-Reported Visual Difficulty and Daily Activity Limitations: The Moderating Role of Neighborhood Characteristics

BACKGROUND AND OBJECTIVES

Understanding how neighborhood-level factors moderate the relationship between visual health and activity limitations could inform strategies for successful aging in place among older adults with sensory impairments. Guided by a vision loss impact framework, this study aims to examine whether neighborhood social cohesion and physical disorder moderate the association between visual difficulty and activity limitation.

RESEARCH DESIGN AND METHODS

Secondary analyses were conducted using data from Round 5 of the National Health and Aging Trend Study. A 4-level indicator was used to indicate the visual difficulty. Neighborhood social cohesion and physical disorder were each measured using a 3-item scale. Summary scores were created for daily activity limitations. Ordinary least squares regressions were performed to test the study hypotheses. The complex survey design factors were applied. Missing data were handled using multiple imputations.

RESULTS

Older adults reporting any type of visual difficulty experienced more limitations in self-care tasks, household activities, and mobility than those without visual difficulty. Neighborhood physical disorder moderated visual difficulty and activity limitations. Specifically, visual difficulty was associated with higher risk of activity limitations among participants perceiving physical disorder in the neighborhood compared to those perceiving no physical disorder.

DISCUSSION AND IMPLICATIONS

The study findings suggest that the vision loss impact framework provides an integrative approach to identify the health needs of older adults with visual difficulty. Future research is needed to further understand the role of neighborhood in independent living among older adults with visual difficulty and to inform community-level interventions.

Assessing the degree of urbanisation using a single-item self-report measure: a validation study

The differential impact of rural versus urban residence on mental health remains a controversial topic that requires more in-depth investigations. This calls for a valid and easy measure to assess the degree of urbanisation. The purpose of the present study was to determine the utility of a single-item self-report measure (SIDU) as a tool to classify areas along the rural-urban continuum. The validity of the SIDU was assessed by comparing its scores (1-7) to a commonly used objective surrogate measure of the degree of urbanisation (i.e. surrounding address density, SAD) in two independent older adult samples (A: N = 36, 65+; B: N = 121, 55+). SIDU scores approximated SAD scores, with r = .77 to 0.82, (A), and r = .79 to 0.83 (B). A SIDU threshold score of 6 most accurately distinguished extremely urbanised areas from other areas. Altogether, our findings suggest that SIDU scores could be used as proxy of SAD. Since self-report leaves room for the consideration of additional aspects that confer an urban settlement, this single-item scale may be even more comprehensive, and circumvents the collection and handling of highly sensitive location data when the primary goal is solely to distinguish urbanisation subgroups.

Urbanicity and cognitive functioning in later life

Introduction

Prior research has shown disparities in cognitive functioning across the rural-urban continuum. We examine individual- and contextual-level factors to understand how and why urbanicity shapes cognitive functioning across older adulthood.

Methods

Using a nationally representative sample from 1996 to 2016 waves of the Health and Retirement Study (HRS) and growth curve models, we assess urban-suburban-exurban differences in older adult cognitive functioning.

Results

Results demonstrate that older adult men and women living in exurban areas, and older adult men in suburban areas, have lower cognitive functioning scores compared to their urban peers. Educational attainment and marital status contribute to but do not fully explain these differences. There were no differences in the trajectory over age, suggesting that urbanicity disparities in cognition occur earlier in life, with average differences remaining the same across older adulthood.

Discussion

Differences in cognitive functioning across urbanicity are likely due to factors accumulating prior to older adulthood.

A Social-Ecological Approach to Understanding Activity Engagement Patterns Among Older Chinese Immigrants

Few studies have focused on activity engagement among older immigrants. We aim to map the patterns of activity engagement and examine the associations with social-ecological factors in a sample of older Chinese immigrants. Participants were from the Population Study of Chinese Elderly in Chicago (PINE). Four patterns of activity engagement were identified through latent class analysis: restricted, diverse, informal social, and community-based social. Intrapersonal, interpersonal, cultural, and environmental factors distinguished latent classes of activity engagement. In particular, acculturation and family-oriented immigration differentiated the restricted from the diverse class membership. Positive attributes of social environment such as social network size, positive social support, and neighborhood cohesion were associated with the likelihood of categorization in the diverse, informal social, and community-based social groups relative to the restricted group. Findings point to the importance of positive attributes of social environment in enhancing engagement with life among older Chinese immigrants.

'My neighbourhood is fuzzy, not hard and fast': Individual and contextual associations with perceived residential neighbourhood boundaries among ageing Americans

Neighborhoods are fluid social and spatial constructs that vary by person and place. How do residential neighborhoods shift as people age? This mixed-method study investigates how perceived neighborhood boundaries and size vary by individual and contextual characteristics. Semi-structured interviews with 125 adults aged 55-92 living in the Minneapolis (Minnesota) metropolitan area suggested that neighborhood boundaries are "fuzzy". Qualitative thematic analysis identified duration of residence and housing stability, race, life-space mobility, social capital, sense of safety, and the built and social environment as key neighborhood determinants. This informed quantitative analyses among 7,811 respondents (mean age 72) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study who self-reported how many blocks composed their neighborhoods. We tested individual and contextual factors identified in the qualitative results as related to perceived neighborhood size. Three-level gamma regression models showed that being older, white, less educated, lower income, less physically and cognitively healthy, less active, less socially supported, and feeling unsafe were significantly associated with smaller self-reported neighborhood sizes. Further, living in less racially diverse, less dense, and less affluent areas were significantly associated with smaller neighborhoods. The mixed-methods findings deepen understanding of scale in neighborhood-based research, inform urban planning interventions, and help understand what "neighborhood" means among diverse aging Americans.

Social determinants of memory change: A three-year follow-up of the Canadian Longitudinal Study on Aging (CLSA)

OBJECTIVES

Changes in memory can interfere with activities of daily living and may be indicative of serious health concerns such as mild cognitive impairment or dementia. Risk factors for cognitive decline and dementia have been shown to cluster around inequalities, suggesting that minority groups may be at an increased risk for cognitive decline. We sought to clarify the relationship between social determinants and change in memory function over a 3-year follow-up period, after accounting for demographic and health variables.

METHODS

We used baseline and first follow-up data from the Canadian Longitudinal Study on Aging (CLSA). Our primary analysis consisted of a multivariable linear regression model (n = 30,475). Demographic, health, education and occupation, social support, social identity, and social positioning variables (predictors) were measured at baseline. We computed a reliable change index (outcome) using the Rey Auditory Verbal Learning Test (RAVLT).

RESULTS

Older age and some health considerations (e.g., higher body mass index, low hearing) were associated with a greater decline in memory over the three-year period. In contrast, some physical activity and better self-rated general health were associated with improvements in memory. Having a hobby and better perceived social standing were associated with greater memory improvement. Social identities who experience minority stress (sexual orientation, gender identity, and race) did not predict change in memory.

DISCUSSION

Altogether, these results contribute to a growing body of evidence that points to older members of minoritized communities exhibiting initial differences in cognitive functioning (i.e., cross-sectional differences) but not more rapid cognitive aging.

The influencing factors of elder-friendly public open spaces promoting older adults' health in deprived urban neighborhoods: Partial Least Square Structural Equation Modeling approach

Background

Public open spaces (POSs) is considered a feature of the built environment that is important for physical, mental, and social health during life and contributes to active aging. Hence, policymakers, practitioners, and academics have recently focused on indicators of elder-friendly environments, particularly in developing countries.

Objective

This study aimed to examine the attributes of POSs and socio-demographic status that positively influence older people's health in Tehran's deprived neighborhoods using a pathway model.

Methods

We employed a pathway model to explore the relationships between place function, place preferences, and process in the environment as the perceived (subjective) positive features of POSs associated with older adults' health, compared to the objective attributes of POSs. We also included personal characteristics, including physical, mental, and social dimensions, to explore how these factors are related to the health of older adults. To assess the subjective perception of POSs attributes, 420 older adults were asked to complete Elder-Friendly Urban Spaces Questionnaire (EFUSQ) from April 2018 to September 2018 in the 10th District of Tehran. We used the SF-12 questionnaire and "The self-Rated Social Health of Iranians Questionnaire to measure older people's physical and mental health and elder social health." Geographical Information System (GIS) measures (Street connectivity, Residential density, Land use mix, Housing quality) were derived as objective measures of neighborhood features.

Results

According to our findings, the personal aspect, socio-demographic status (such as Gender, Marital status, Education, Occupation as well as Frequency of being present in POSs), place preferences (Security, Fear of Falling, Way Finding and Perceived Aesthetics), and process in the environment's latent (Social Environment, Cultural Environment, Place Attachment, and Life Satisfaction)constructs collectively influenced the elders' health.

Conclusion

We found positive associations between Place preference, Process-in-environment, and personal health-related factors to elders' health (social, mental, and physical). The path model presented in the study could be guided in future research in this area and inform the development of evidence-based urban planning and design interventions for improve older adults health and social functioning and quality of life.

Walkable Neighborhoods and Cognition: Implications for the Design of Health Promoting Communities

Objective: This study seeks to examine neighborhood characteristics, physical activity, and health status and their roles in promoting healthy cognitive aging. Methods: Using data from the REasons for Geographic And Racial Difference in Stroke (REGARDS) study (N=10,289, mean age=73.4 years), we used multilevel linear regression to examine the relationships between walkable neighborhoods (both objectively measured and subjective perceptions), walking behavior, physical activity, health status, and cognitive function. Results: Engaging in any moderate physical activity (β=0.47, p < 0.001), having better health status (β=0.02, p < 0.001), living in neighborhoods with greater street connectivity (β=0.15, p < 0.05), and positive perceptions of neighborhood traffic (p < 0.01) and parks (p < 0.05), were associated with higher cognitive function. Residence in socioeconomically disadvantaged neighborhoods (β=-0.01, p < 0.01) was negatively associated with cognitive function. Discussion: Both perceived and objective features of walkable environments may have consequences for cognitive health, and can inform the development of health promoting communities.

Rural depopulation and the rural-urban gap in cognitive functioning among older adults

PURPOSE

As the population ages, the number of people with cognitive impairment will rapidly increase. Although previous research has explored the rural-urban gap in physical health, few studies have analyzed cognitive health. The purpose of this study was to examine rural-urban differences in cognitive health, with a focus on the moderating effect of population decline.

METHODS

The study used individual-level nationally representative data from the 2000-2016 waves of the Health and Retirement Study (N = 152,444) merged to county-level contextual characteristics. Hierarchical linear models were used to predict the cognitive functioning of US adults aged 50 and over by rural-urban residence, county depopulation, and their interactions while controlling for individual-level and county-level demographic and contextual factors.

FINDINGS

Older adults living in rural counties had lower cognitive functioning than urban adults. The interaction between living in a rural and depopulated county was statistically significant (P < .001). The rural penalty in cognitive functioning was 40% larger for those who lived in counties that lost population between 1980 and 2010 compared to those who lived in stable or growing rural counties. These results were independent of race-ethnicity, gender, age, education, income, region, employment status, marital status, physical health, and depression as well as the county's racial-ethnic composition, age structure, economic and educational disadvantage, and health care shortages.

CONCLUSIONS

The results have important implications for those seeking to reduce health disparities both between rural and urban older adults and among different groups of rural people. Interventions targeting those living in rural depopulating areas are particularly warranted.

Cognability: An Ecological Theory of neighborhoods and cognitive aging

While a growing body of evidence points to potentially modifiable individual risk factors for dementia, the built and social environments in which people develop and navigate cognitive decline are largely overlooked. This paper proposes a new theoretical concept, Cognability, to conceptualize how supportive an area is to cognitive health among aging residents. Cognability incorporates a constellation of both positive and negative neighborhood features related to physical activity, social interaction and cognitive stimulation in later life. We analyzed data from the REasons for Geographic And Racial Differences in Stroke Study, a national sample of older Black and white adults in the United States (n = 21,151; mean age at assessment = 67; data collected 2006-2017). Generalized additive multilevel models examined how cognitive function varied by neighborhood features. Access to civic and social organizations, recreation centers, fast-food and coffee establishments, arts centers, museums, and highways were significantly associated with cognitive function. Race-, gender-, and education-specific models did not yield substantial improvements to the full-model. Our results suggest that the unequal distribution of amenities and hazards across neighborhoods may help account for considerable inequities observed in cognitive health among older adults. Cognability advances ecological theories of aging through an innovative "whole neighborhood" approach. It aims to identify which specific neighborhood features are most protective of cognitive health among aging adults to inform upstream public health initiatives, community interventions, and policy.

Adolescent neighborhood disadvantage and memory performance in young adulthood

OBJECTIVE

Using data from the National Longitudinal Study of Adolescent to Adult Health, we estimated the average causal effect of neighborhood disadvantage in adolescence on memory performance in young adulthood. We contrasted several different ways of operationalizing a continuous measure of neighborhood disadvantage including a continuous neighborhood disadvantage score and ordinal measures.

RESULTS

Neighborhood disadvantage was measured in Wave I when participants were a mean age of 15.41 years (SE: 0.12) and memory performance was measured in Wave IV when participants were a mean age of 28.24 years (SE: 0.12). We found that adolescent neighborhood disadvantage was associated with decreased memory performance in young adulthood. Notably, we observed a linear decline in word recall score among those in the less disadvantaged tail of the distribution (neighborhood disadvantage <1), a finding not observed using traditional ordinal variable classifications of disadvantage.

CONCLUSION

Experiencing neighborhood disadvantage in adolescence may have lasting impacts on cognitive health throughout the life course.

Disorder, networks, and cognition: do social networks buffer the influence of neighborhood and household disorder on cognitive functioning?

OBJECTIVES

To examine whether neighborhood and household disorder matter for cognitive functioning among middle-aged and older adults and whether the disorder-cognition link is moderated by social network resources.

METHOD

Data are drawn from National Social Life, Health, and Aging Project (NSHAP) Wave 2 (N = 3198). Both neighborhood and household were considered as key residential contexts that shape one's social life and health. Exposure to neighborhood and household disorder was measured using interviewer assessments of signs of disorder and decay, including the presence of disrepair, trash, noise, and unpleasant smells such as air pollution, in the buildings and streets in which the respondent lives. Cognitive function was measured using the survey-adapted Montreal Cognitive Assessment (MoCA-SA). Network size, network range, and frequency of interaction among network members were assessed as moderators.

RESULTS

Neighborhood and household disorder were independently associated with cognitive function. However, disorder in the household appeared to have more direct associations with cognitive function than did the neighborhood when both were present. The association between household disorder and cognitive function was mitigated by network size, such that poor housing conditions were associated with lower cognitive function only for those with small social networks.

CONCLUSION

This study suggests a larger network may play a role in minimizing the negative influence of household disorder on cognitive function for middle-aged and older adults. Social policy and intervention aimed at promoting network ties may help reduce further disparities in cognitive function, especially for those vulnerable groups living in a poor-quality household.

Psychometric evaluation of the Decision Support Tool for Functional Independence in community-dwelling older people

Background

The aging population is increasingly faced with daily life limitations, threatening their Functional Independence (FI). These limitations extend different life domains and require a broad range of community-care professionals to be addressed. The Decision Support Tool for Functional Independence (DST-FI) facilitates community-care professionals in providing uncontradictory recommendations regarding the maintenance of FI in community-dwelling older people. The current study aims to determine the validity and reliability of the DST-FI.

Methods

Sixty community-care professionals completed a twofold assessment. To assess construct validity, participants were asked to assign predefined recommendations to fifty cases of older people to maintain their level of FI. Hypotheses were tested regarding the expected recommendations per case. Content validity was assessed by questions on relevance, comprehensiveness, and comprehensibility of the current set of recommendations. Twelve participants repeated the assessment after two weeks to enable both within- and between rater reliability properties, expressed by an Intraclass Correlation Coefficient.

Results

Seven out of eight predefined hypotheses confirmed expectations, indicating high construct validity. As the recommendations were indicated 'relevant' and 'complete', content validity was high as well. Agreement between raters was poor to moderate while agreement within raters was moderate to excellent, resulting in moderate overall reliability.

CONCLUSION

The DST-FI suggests high validity and moderate reliability properties when used in a population of community-dwelling older people. The tool could facilitate community-care professionals in their task to preserve FI in older people. Future research should focus on psychometric properties like feasibility, acceptability, and developing and piloting strategies for implementation in community-care.

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.

Effects of Lifestyle Factors on Cognition in Minority Population of Older Adults: A Review

The onset of dementia and Alzheimer's disease (AD) is projected to expand over the next several decades in the United States as the population ages. However, the cognitive health burden is not equally distributed among the population, as Hispanics and African Americans are at higher risk of AD when compared with Non-Hispanic Whites. There is some evidence to indicate that cognitive decline may be associated with lifestyle factors and that interventions in these domains may prevent or delay this decline. These lifestyle factors include social engagement, physical activity, both aerobic and strength training, dietary intake, sleep and stress. This review summarizes, in general, what is known about the relationship between risk factors and cognition and, in particular what is known about this relationship in minority populations. The results show that the relationship between these risk factors and cognitive decline is stronger for some of the factors such as physical activity and dietary intake and weaker for the other factors depending on what is measured and in what populations. It does appear, however, that the studies in minority populations is limited and warrants more targeted research and interventions.

Neighborhood Social Cohesion and the Health of Native Hawaiian and Other Pacific Islander Older Adults

Native Hawaiian and other Pacific Islander (NHPI) older adults experience various social and health challenges. There is a growing literature linking neighborhood conditions with health, yet few have focused on NHPI older adults. This study examines associations between neighborhood social cohesion and health outcomes (i.e., self-rated health, psychological distress, and memory) in this population. Data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (n=1,045 with respondents aged 50+) were analyzed with logistic regression models. The level of neighborhood social cohesion was determined by responses to items on perceptions of mutual help, dependability, trust, and close relationships within the neighborhood. Higher perceived neighborhood social cohesion was associated with lower odds of having serious psychological distress or memory problems. There was no statistical association of social cohesion with self-rated health. Socially cohesive neighborhoods are important to the health of NHPI. We discuss methods to improve neighborhood social cohesion as a way to promote health equity for NHPI older adults in the United States (U.S.).

Novel Insights From Interviewer Assessments of Personal Attributes, Home Environment, and Residential Context in NSHAP

OBJECTIVES

This study was aimed to describe the interviewer-assessed measures present in the 2015/2016 Round of National Social Life, Health, and Aging Project (NSHAP), outline strengths of interviewer-assessed measures, and explore how interviewer assessments in the domains of home environment and personal characteristics are associated with older adult health.

METHOD

Data come from the 2015/2016 Round of the NSHAP.

RESULTS

We provide descriptive results from the interviewer assessments of personal attributes, indoor home environment, and outdoor residential context. We present an illustrative analysis of reports of falls, a health outcome that might be predicted by characteristics assessed by the interviewer, and we suggest directions for further research.

DISCUSSION

Interviewer assessments collected in NSHAP are useful as proxy measures and can be used in combination with respondent's reports and ecological measures to generate insights into healthy aging.

Social Relationships in Early Life and Episodic Memory in Mid- and Late Life

OBJECTIVES

This study examines the longitudinal relationships between retrospective reports of early-life social relationships (i.e., having good friends, parent-child relationship quality, and childhood neighborhood social cohesion) and episodic memory in China.

METHODS

We analyzed 2 waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study. The analytical sample included 9,285 respondents aged 45 and older at baseline. A lagged dependent variable approach was used to estimate the associations between measures of early-life social relationships and episodic memory change at the study's 4-year follow-up.

RESULTS

Retrospective reports of better early-life social relationships are significantly associated with higher levels of episodic memory performance in 2015 among middle-aged and older Chinese, controlling for episodic memory in 2011, childhood socioeconomic status, adulthood sociodemographic variables, and the history of stroke. Educational attainment accounts for a significant portion of the associations between early-life social relationships and episodic memory. In contrast, mental health and social engagement in adulthood account for a small part of these associations.

DISCUSSION

The findings suggest that positive early-life social relationships are beneficial for episodic memory in mid- and late life, and more research is needed to examine the underlying mechanisms.

Neighborhood built environment associated with cognition and dementia risk among older adults: A systematic literature review

Cognitive impairment associated with aging is a serious and growing public health problem. This systematic literature review contributes to better understanding the current state of knowledge on the roles of neighborhood environments in supporting cognitive health in later life. Literature search was carried out in 2020 using the seven databases most relevant to the topic. This review was restricted to peer-reviewed observational and quantitative studies that focused on 1) community-dwelling older adults as target populations; 2) neighborhood built environments as independent variables; and 3) cognition or dementia as outcome variables. Thirty-seven studies published between 1989 and 2020 met the inclusion criteria. The neighborhood built environment domains covered in these included urbanity/rurality, land use, neighborhood physical disorder, transportation infrastructure, urban design, and urban nature. Neighborhood resources and green space exposure were most frequently studied and linked to cognition-related outcomes. Neighborhood built environment was shown to be more pertinent to older adults' global cognition, memory, and dementia. Physical activity showed a mediating role between neighborhood built environment and cognition. The effect of neighborhood built environment on cognitive function was stronger among older women and those with disabilities or lower socioeconomic status. Evidence on the relationship between neighborhood built environment and cognition/dementia among older adults is moderate. Our findings highlight the need for more standardized and longitudinal measures of neighborhood built environment and high-sensitivity cognitive tests that capture the specific and relevant domains of cognition, to facilitate further exploration of the mediating and moderating effects of neighborhood built environment with cognition/dementia in older adults. This review offers insights for future research and policy efforts toward creating communities to support cognitive health and aging in place.

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.

Association of social deprivation with cognitive status and decline in older adults

OBJECTIVES

Social deprivation, i.e. the relative deprivation in socioeconomic domains, is known to exacerbate disease risk. Less is known about its role in cognitive functioning and decline in older adults. This study aimed to investigate the association between social deprivation and cognitive status as well as rate of decline.

METHODS

We analysed data from the nationally representative Health and Retirement study (HRS) of individuals aged 50 and older. The analysis sample contained 11,101 respondents (mean age at baseline: 69.4, SD: 8.6%, 55% female) with at least two cognitive assessments (mean follow up: 11.2, SD: 5.4). To quantify social deprivation we constructed a social deprivation index (SDI) with structural equation modelling. Multiple growth curve modelling was used to model cognitive status and decline as predicted by SDI.

RESULTS

After adjusting for covariates, greater social deprivation was associated with poorer cognitive status (β = -0.910, p < 0.001; 95% CI: -0.998-0.823) and faster cognitive decline (β = -0.005, p = 0.002; 95% CI:-0.009-0.002). Of the covariates, depressive symptoms, chronic disease burden, belonging to a racial or ethnical minority, and male gender were also associated with poorer cognitive status. Marriage statuses other than being married or partnered had a positive association with cognitive status.

CONCLUSIONS

Our findings indicate that greater social deprivation was associated with significantly poorer cognitive status implying that preventing social deprivation can contribute to raising cognitive functioning in the older population and help reduce the incidence of dementia. Policy that facilitates early intervention in social deprivation will be key.

A comparison of spouse and non-spouse carers of people with dementia: a descriptive analysis of Swedish national survey data

BACKGROUND

Being an informal carer of a person with dementia (PwD) can have a negative effect on the carer's health and quality of life, and spouse carers have been found to be especially vulnerable. Yet relatively little is known about the care provided and support received by spouse carers. This study compares spouse carers to other informal carers of PwDs regarding their care provision, the support received and the psychosocial impact of care.

METHODS

The study was a cross-sectional questionnaire-based survey of a stratified random sample of the Swedish population aged 18 or over. The questionnaire explored how much care the respondent provided, the support received, and the psychosocial impact of providing care. Of 30,009 people sampled, 11,168 (37.7 %) responded, of whom 330 (2.95 %) were informal carers of a PwD.

RESULTS

In comparison to non-spouse carers, spouse carers provided more care more frequently, did so with less support from family or the local authority, while more frequently experiencing negative impacts on their social life and psychological and physical health. Spouse carers also received more carer support and more frequently experienced a closeness in their relationship with the care-recipient.

CONCLUSIONS

Spouse carers of PwD differed from non-spouse carers on virtually all aspects of their care situation. Policy and practice must be more sensitive to how the carer-care-recipient relationship shapes the experience of care, so that support is based on an understanding of the individual carer's actual needs and preferences rather than on preconceptions drawn from a generalised support model.

Neighborhood Socioeconomic Resources and Crime-Related Psychosocial Hazards, Stroke Risk, and Cognition in Older Adults

Living in neighborhoods with lower incomes, lower education/occupational levels, and/or higher crime increases one’s risk of developing chronic health problems including cardiovascular disease risk factors and stroke. These cardiovascular health problems are known to contribute to cognitive decline and dementia. The purpose of this study was to determine the association of neighborhood socioeconomic resources and crime-related psychosocial hazards on stroke risk and cognition, hypothesizing that cardiovascular health would mediate any relationship between the neighborhood-level environment and cognition. The study evaluated 121 non-demented Chicago-area adults (~67 years; 40% non-Latino White) for cardiovascular health problems using the Framingham Stroke Risk Profile 10-year risk of stroke (FSRP-10). The cognitive domains that were tested included memory, executive functioning, and attention/information processing. Neighborhood socioeconomic resources were quantified at the census tract level (income, education, and occupation); crime-related psychosocial hazards were quantified at the point level. Structural equation modeling (SEM) did not show that the FSRP-10 mediated the relationship between neighborhood characteristics and domain-specific cognition. The SEM results did suggest that higher crime rates were associated with a higher FSRP-10 (β(105) = 2.38, p = 0.03) and that higher FSRP-10 is associated with reduced attention/information processing performance (β(105) = −0.04, p = 0.02) after accounting for neighborhood socioeconomic resources. Clinicians may wish to query not only individual but also neighborhood-level health when considering cognition.

Correlates of memory and executive function in mid-aged and older adults in the CLSA: A minority stress approach

OBJECTIVES

Maintaining cognitive function is an important component of healthy aging. There is increasing recognition that extraneous factors expedite the typical cognitive aging process. Risk factors for cognitive decline cluster around inequalities and disproportionally affect minority and vulnerable groups. Taking a minority stress approach, we examined the relationship between proxy measures of minority stress and cognitive health in a large sample of Canadians aged 45-85 years.

METHODS

Data were drawn from the baseline of the Canadian Longitudinal Study on Aging (CLSA), a prospective cohort study. Memory (n = 36,849) and executive function (n = 36,266) were assessed using standardized assessment tools. We ran multiple linear regression models with memory and executive function as the outcomes. Explanatory variables included known correlates of cognitive health (i.e., demographic, health, and cognitive reserve) and proxy measures of minority stress (i.e., sexual orientation, race, and perceived social standing).

RESULTS

Results were consistent with existing evidence showing that demographic and health variables were associated with cognitive performance. Modifiable health variables, walking and fruit/ vegetable consumption were associated with better cognitive performance, as were cognitive reserve and social support measures. Within the models, racial minority status was consistently associated with lower cognitive performance. As one's perceived social standing within their own community increased, so too did cognitive function.

DISCUSSION

These findings identify factors that may put people at risk for cognitive decline. There is a need to support the cognitive health of racialized Canadians and members of other disadvantaged groups, while promoting health equity.

Neighborhood disadvantage is associated with stable deficits in neurocognitive functioning in traumatically-injured adults

BACKGROUND

In trauma-exposed adults, the relationship between an individual's socioeconomic position (SEP) and post-traumatic stress disorder (PTSD) has been well demonstrated. One potential mechanism by which the stress associated with lower SEPs may impact trauma outcomes is through changes in neurocognition. In both healthy and clinical samples, area-level factors also appear to be independently related to neurocognition. Far less is known about how neighborhood socioeconomic disadvantage, may impact cognition in traumatically-injured adults. The current study employed hierarchical linear modeling to longitudinally investigate whether neighborhood disadvantage was associated with neurocognitive functioning in five domains: processing speed, sustained attention, controlled attention, cognitive flexibility, and response inhibition.

METHODS

One-hundred and ninety-five socioeconomically diverse traumatically-injured subjects (mean age = 32.8, 52.8% female) were recruited from an Emergency Department. Two-weeks, three-months, and six-months post-trauma, participants completed self-report measures and a computerized test battery to evaluate neurocognition. An Area Deprivation Index (ADI) score, a measure of a neighborhood's socioeconomic disadvantage, was derived from each participants' home address.

RESULTS

Greater neighborhood disadvantage was significantly related to lower scores in all domains. Results of hierarchical linear models revealed neighborhood disadvantage was significantly associated with processing speed, controlled attention, cognitive flexibility, and response inhibition across time, even after adjusting for individual annual household income, baseline PTSD symptoms, and previous adverse life experiences. This relationship was stable for all domains except sustained attention, which varied across time.

CONCLUSION

These findings indicate neighborhood disadvantage contributes uniquely to neurocognitive functioning and, for the majority of domains, these contributions are stable across time. The relationship between area-level variables and cognitive function may underlie individual vulnerability to developing psychiatric disorders. Future work should continue to examine the interaction between socioenvironmental stressors and PTSD symptoms longitudinally.

Neighborhood Characteristics and Frailty: A Scoping Review

BACKGROUND AND OBJECTIVES

Frailty is highly prevalent in later life and associated with early mortality and adverse health outcomes. The neighborhood has been identified as an important contributor to individual health, and neighborhood characteristics may contribute to frailty development. A scoping review was conducted of the peer-reviewed literature to better understand how physical and social neighborhood characteristics contribute to frailty.

RESEARCH DESIGN AND METHODS

Following an established scoping review methodology, we searched four peer-reviewed databases for relevant studies published from January 1, 2008, to December 31, 2018. Data extracted from studies included study characteristics, operationalization of neighborhood, the conceptual model of the neighborhood-frailty relationship, operationalization of frailty, and study findings for associations among neighborhood variables and frailty indicators.

RESULTS

A total of 522 articles were identified and 13 articles were included in the final data charting. Existing studies suggest that neighborhood characteristics are associated with frailty in later life. Few studies articulated a conceptual model identifying exact mechanisms through which neighborhood factors affected frailty. Studies designs were mostly cross-sectional. Longitudinal studies did not measure neighborhood characteristics over time. Studies varied considerably in how they operationalized the neighborhood. Frailty was most commonly assessed using a 5-point phenotype or a frailty index approach.

DISCUSSION AND IMPLICATIONS

Findings indicate that research on the relationship between neighborhood characteristics and frailty is an emerging area of inquiry. Additional studies are needed to more definitely explicate mechanisms through which neighborhoods contribute to, or protect older adults from, frailty.

The role of neighborhood stressors on cognitive function: A coordinated analysis

The objective of this study was to evaluate the association between perceived neighborhood stressors, encompassing negative perceived neighborhood characteristics, and specific cognitive abilities in adulthood. We conducted a coordinated analysis across three studies of adults in the United States and found that perceived neighborhood stressors were consistently associated with poorer performance on attention-demanding cognitive tasks. We specifically found that perceived neighborhood stressors were associated with lower performance in spatial abilities, working memory, and executive function but not perceptual speed, and that the effect was most consistent for lower perceived neighborhood safety followed by lower perceived aesthetic quality, greater perceived neighborhood crime, and lower perceived neighborhood cohesion. These results highlight the importance of the psychosocial neighborhood context for cognitive health in adulthood.

Importance of Activity Engagement and Neighborhood to Cognitive Function Among Older Chinese Americans

This study investigates the differential associations of activity engagement and perceived neighborhood characteristics (i.e., cohesion, disorder, sense of community) with cognitive measures. Using data of 2,713 Chinese older adults in Chicago, who completed two interviews between 2011 and 2015, we identified three activity domains: reading, social, and games. In general, engagement in more reading and social activities was associated with better baseline cognitive function, but the positive effects tapered off over time in some cases. Neighborhood cohesion had both direct and indirect effects on cognitive function. Engagement in social activities mediated the neighborhood cohesion effects, that is, living in a cohesive neighborhood promoted social activities and consequently benefited cognitive function. Findings speak to the importance of activity engagement and neighborhood cohesion for cognition among the U.S. Chinese older adults. Future research is needed to investigate the longitudinal relationships of activity engagement and environmental factors with cognitive change.

Family Ties and Aging in a Multiethnic Cohort

Objective: Lack of social support is linked to lower cognitive function and cognitive decline. We investigated the effects of a specific type of social relationship, family ties, on cognitive trajectories in non-Hispanic whites, non-Hispanic blacks, and Hispanics. Methods: Using multiple-group latent growth curve models, we analyzed associations between the number of children/grandchildren/siblings/other relatives contacted within the past month at baseline and cognitive trajectories in 1420 older adults who were nondemented at baseline. Language, memory, and visuospatial abilities were assessed at baseline and at 18- and 24-month follow-ups for up to six visits. Inferential analyses assessed the differential effects of sex/gender and race/ethnicity for each family tie. Results: Independent of all covariates, contact with more relatives was associated with better initial memory (b = .01) and language functioning (b = .01) across race/ethnicity and sex/gender. Conclusion: The size of peripheral rather than immediate family networks may be more likely to affect cognitive function in older adults.

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.