Hilly environment and physical activity among community-dwelling older adults in Japan: a cross-sectional study

Factors associated with prefectural level physical activity in Japan: An ecological study

Background

Physical activity inequalities are an important global concern; nonetheless, few studies have comprehensively examined the association between physical activity inequalities and related factors. We aimed to explore factors associated with regional inequalities in physical activity in Japan.

Methods

We investigated the relationship of individual, psychological/behavioral, social, and built-environmental factors with the proportion of individuals with exercise habits across Japanese prefectures. We sourced data from open databases, including the Japanese National Health Insurance Claims and Nationwide Screening Program Database. We defined exercise habits as engaging in at least 30 min of moderate exercise at least twice a week. We employed multiple regression analysis to identify factors associated with prefectural level physical activity.

Results

The median proportion of individuals with exercise habits was 27% (interquartile range, 25-29). Higher frequency of exercise habits was associated with higher frequency of history of exercise (coefficients, 0.60; 95% confidence interval, 0.41-0.80) and lower proportion of female gender (coefficients, -1.74; 95% confidence interval, -2.80 to -0.69).

Conclusions

Exercise history and female gender may be related to prefectural level physical activity in Japan. Physical activity interventions should be promoted among women without exercise history.

Built Environments and Frailty in Older Adults: The JAGES Longitudinal Study Using Mediation Analysis

OBJECTIVES

The purpose of this study was to investigate the association between subjective built environment and the onset of frailty in older adults living in the community. In addition, we examined whether daily walking time, depressive symptoms, and social support from neighbors and friends are mediating factors.

DESIGN

This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study.

SETTING AND PARTICIPANTS

Participants included 38,829 older adults who were not frail recruited from 22 cities and towns.

METHODS

The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were 5 items for the subjective built environment. The mediating variables were walking time of at least 30 minutes per day, a Geriatric Depression Scale (GDS) score of at least 5 points, and social support from neighbors and friends. We performed a causal mediation analysis of mediating effects between each built environment and frailty onset. Furthermore, the proportion of mediation was estimated.

RESULTS

After 3 years of follow-up, frailty emerged in 2232 adults (6.7%) in 2016. Access to parks and sidewalks, access to fresh food stores, houses or facilities where people feel free to drop in, and fascinating views, or buildings reduced the onset of frailty. Mediators significantly associated with the built environment and onset of frailty were access to parks and sidewalks (walking time: 5.9%, GDS: 22.9%, social support: 5.9%), access to fresh food stores (GDS: 31.9%, social support: 4.0%), hills and steps (GDS: 20.6%), houses or facilities where people feel free to drop in (walking time: 4.0%, GDS 28.0%, social support: 10.4%), and fascinating views, or buildings (walking time: 7.8%, GDS: 42.1%, social support: 12.0%).

CONCLUSIONS AND IMPLICATIONS

We found that walking time, depression, and social support were mediating factors in the relationship between built environment and the onset of frailty.

Built environments and frailty in older adults: A three-year longitudinal JAGES study

BACKGROUND

This study investigated the relationship between built environments and the onset of frailty after 3 years.

METHODS

This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study on 38,829 older adults nested in 562 comunnities who were not frail. The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were eight items for the built environment at the individual and community levels. To consider each level of built environment simultaneously, multilevel Poisson regression analysis was used to calculate risk ratios and 95% confidence intervals.

RESULTS

After 3 years of follow-up, the onset of frailty was 2740 (7.1%) in 2016. At the individual level, there was an increased risk of developing frailty in negative built environments, such as locations with graffiti or garbage (incidence rate ratio (IRR), 1.15; confidence interval (CI), 1.05-1.25). Positive built environments, such as areas with access to parks and sidewalks (IRR, 0.78; CI, 0.70-0.88), lowered the risk of developing frailty. At the community level, the risk of developing frailty was lower only in areas with locations difficult for walking (hills or steps) (IRR, 0.97; CI, 0.94-0.99).

CONCLUSIONS

At the individual level, frailty onset was associated with all built environments. However, irrespective of their answers, there was a lower risk of developing frailty among older adults living in areas where walking was difficult. It would be desirable to verify whether the risk of developing frailty can be reduced by changing the built environment.

Hilly environment and frequency of going out-of-home among older adults: Examining moderating effect of driving status

AIM

The health benefits of "going out-of-home" frequently among older adults are well known. A hilly environment would inhibit this habit. This study examined (i) longitudinal associations between a hilly environment and the frequency of going out-of-home, and (ii) the moderating effect of driving status on their association among older adults.

METHODS

This study involved a longitudinal study design. Data on 856 older adults in Nada Ward, Kobe, Japan, was obtained from a three-wave questionnaire survey (Wave 1: December 2017 to January 2018; Wave 2: after 1 year; Wave 3: after 3 years). In each survey, the frequency of going out-of-home time was measured. The average land slope within 500 m network buffers of each participant's home was calculated as the index of the hilly environment. Driving status was also measured.

RESULTS

The latent growth model revealed that while a higher value of average land slope was not significantly associated with changes in the frequency of going out-of-home over time, it was significantly associated with a lower frequency of going out-of-home at the initial level. The interaction term in the latent growth model showed that driving status did not moderate the associations of the average land slope with the initial level of, and changes in, the frequency of going out-of-home.

CONCLUSIONS

Although it remains unclear whether a hilly environment would accelerate a decline in the frequency of going out-of-home over time, this study found that older adults living in a hilly environment were less likely to leave their homes. Geriatr Gerontol Int 2022; ••: ••-••.

Effect of Urban Green Space in the Hilly Environment on Physical Activity and Health Outcomes: Mediation Analysis on Multiple Greenery Measures

Background: Green spaces reduce the risk of multiple adverse health outcomes by encouraging physical activity. This study examined correlations between urban green space and residents’ health outcomes in hilly neighborhoods: if they are mediated by social cohesion, visual aesthetics, and safety. Methods: We used multiple green space indicators, including normalized difference vegetation index (NDVI) extracted from satellite imagery, green view index (GVI) obtained from street view data using deep learning methods, park availability, and perceived level of greenery. Hilly terrain was assessed by the standard deviation of the elevation to represent variations in slope. Resident health outcomes were quantified by their psychological and physiological health as well as physical activity. Communities were grouped by quartiles of slopes. Then a mediation model was applied, controlling for socio-demographic factors. Results: Residents who perceived higher quality greenery experienced stronger social cohesion, spent more time on physical activity and had better mental health outcomes. The objective greenery indicators were not always associated with physical activity and might have a negative influence with certain terrain. Conclusions: Perceived green space offers an alternative explanation of the effects on physical activity and mental health in hilly neighborhoods. In some circumstances, geographical environment features should be accounted for to determine the association of green space and resident health outcomes.

Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study

Objective: Falls in older adults are a major public health issue, and it is unclear whether the neighborhood environment is associated with falls among this group. This cross-sectional study investigated whether hilly neighborhood environmental factors were associated with fall status (falls or fear of falling) in rural Japanese older adults.

Materials and Methods: Data obtained from 965 participants aged 65 years and older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental factors, the mean elevation and land slope were assessed using a geographic information system. The logistic regression model examined the odds ratios (OR) and 95% confidence intervals (CIs) of fall status in quartiles for elevation and land slope, respectively, and was adjusted for confounders.

Results: Falls and fear of falling were observed in 16.8% and 43.2% of participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI 1.17–3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19–3.44 for Q3 vs. Q1) and land slope (OR 1.74, 95% CI 1.04–2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04–2.93 for Q4 vs. Q1). Fear of falling was associated with elevation (OR 1.78, 95% CI 1.19–2.65 for Q3 vs. Q1) and land slope (OR 1.51, 95% CI 1.01–2.25 for Q4 vs. Q1).

Conclusion: Our study found that elevation and land slope as hilly neighborhood environment factors were positively associated with falls or fear of falling among older adults living in rural Japan. Prospective observational studies that investigate the effects of region-specific environmental factors on falls among older adults should be conducted.

Environmental Factors Affecting Cognitive Function among Community-Dwelling Older Adults: A Longitudinal Study

Although neighborhood environmental factors have been found to be associated with cognitive decline, few longitudinal studies have focused on their effect on older adults living in rural areas. This longitudinal study aimed to investigate the role of neighborhood environmental factors in cognitive decline among rural older adults. The data of 485 older adults aged ≥60 years who were living in Unnan City in Japan and had participated in two surveys conducted between 2014 and 2018 were analyzed. Cognitive function was assessed using the Cognitive Assessment for Dementia, iPad version 2. Elevation, hilliness, residential density, and proximity to a community center were determined using geographic information system. We applied a generalized estimating equation with odds ratios (OR) and 95% confidence intervals (CIs) of cognitive decline in the quartiles of neighborhood environmental factors. A total of 56 (11.6%) participants demonstrated a decrease in cognitive function at follow up. Elevation (adjusted OR 2.58, 95% CI (1.39, 4.77) for Q4 vs. Q1) and hilliness (adjusted OR 1.93, 95% CI (1.03, 3.63) for Q4 vs. Q1) were associated with a higher likelihood of cognitive decline. The second quartiles of residential density showed significantly lower likelihoods of cognitive decline compared with the first quartiles (adjusted OR 0.36, 95% CI (0.19, 0.71) for Q2 vs. Q1). Thus, an elevated hilly environment and residential density predicted cognitive decline among rural older adults.

Neighborhood Environmental Factors and Physical Activity Status among Rural Older Adults in Japan

(1) Background: Although several neighborhood environmental factors have been identified to be associated with older adults’ physical activity, little research has been done in rural areas where the population is aging. This study aimed to investigate neighborhood environmental factors and the longitudinal change of physical activity status among rural older adults in Japan. (2) Methods: The study included 2211 older adults, aged over 60 years, residing in three municipalities in Shimane prefecture and participating at least twice in annual health checkups between 2010 and 2019. Physical activity was identified based on self-report. Hilliness, bus stop density, intersection density, residential density, and distance to a community center were calculated for each subject. Hazard ratios for the incidence of physical inactivity were estimated using Cox proportional hazards models. (3) Results: We found that 994 (45%) of the study subjects became physically inactive during the follow-up. Those living far from a community center had a lower risk of becoming physically inactive compared to those living close to a community center. When the analysis was stratified by residential municipality, this association remained in Ohnan town. Those living in hilly areas had a higher risk of becoming physically inactive in Okinoshima town. (4) Conclusions: The impact of neighborhood environmental factors on older adults’ physical activity status might differ by region possibly due to different terrain and local lifestyles.

Neighborhood environment and muscle mass and function among rural older adults: a 3-year longitudinal study

BACKGROUND

Sarcopenia, resulting from loss of muscle mass and function, is highly prevalent in the ageing societies and is associated with risk of falls, frailty, loss of independence, and mortality. It is important to identify environmental risk factors, so that evidence-based interventions to prevent sarcopenia can be implemented at the population level. This study aimed to examine the potential effect of several objectively measured neighborhood environmental factors on longitudinal change of muscle mass and function among older adults living in rural Japanese towns where the population is ageing.

METHODS

This study was based on data from the Shimane CoHRE Study conducted by the Center for Community-based Healthcare Research and Education (CoHRE) at Shimane University in 3 rural towns in the Shimane Prefecture, Japan. Subjects older than 60 years, who participated in an annual health examination in 2016 and any follow-up years until 2019, i.e., 4 possible time points in total, were included (n = 2526). The skeletal muscle mass index (SMI) and grip strength were assessed objectively for each year as a measure of muscle mass and function, respectively. Neighborhood environmental factors, i.e., hilliness, bus stop density, intersection density, residential density, and distance to a community center were measured by geographic information systems (GIS). Linear mixed models were applied to examine the potential effect of each neighborhood environmental factor on the change of SMI and grip strength over time.

RESULTS

Males living far from community centers had a less pronounced decline in SMI compared to those living close to community centers. Females living in areas with higher residential density had a less pronounced decline in grip strength compared to those living in areas with lower residential density.

CONCLUSIONS

Neighborhood environmental factors had limited effects on change of SMI and grip strength among rural older adults within the 3 years follow up. Further long-term follow up studies are necessary by also taking into account other modifiable neighborhood environmental factors.