Older Adults' Outdoor Walking: Inequalities in Neighbourhood Safety, Pedestrian Infrastructure and Aesthetics

Urban green and blue spaces and general and mental health among older adults in Washington state: Analysis of BRFSS data between 2011-2019

A growing body of evidence highlights the significant effect of built environment features on mental and general health. This study examined the association between distance to and percentage of green and blue space measures and serious psychological distress, general health, and frequent mental distress among older adults living in urban ZIP codes in Washington state. Percentage of green space, particularly tree canopy and forest space, was significantly associated with better self-rated general health and reduced odds of serious psychological distress. Closer distance to blue space was associated with better self-rated general health. Programs which incentivize exposure to green and blue spaces for urban-dwelling, older adults may improve health outcomes.

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

OBJECTIVE

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

DATA SOURCES

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

STUDY SECTION

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

DATA EXTRACTION

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

DATA SYNTHESIS

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

CONCLUSIONS

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

Designing environments that contribute to a reduction in the progression of Parkinson's disease; a literature review

Parkinson's Disease (PD), a prevalent neurological disorder, causes physical difficulties like stiffness and impaired walking and affects patients' emotional well-being. Regular exercise and exposure to enriched environments are crucial to managing these symptoms. This review aims to extract evidence from studies regarding built environments' impact on reducing the progression of PD. Keywords from 2005 to 2022 were used in five databases, including PubMed, Clarivate Web of Science, UGA Library, and Google Scholar. Many studies emphasized physiotherapy and training for physical enhancement, often utilizing virtual games and smart devices. Others highlighted the advantages of non-slip flooring and accessible outdoor spaces, with some based on universal design principles. Few studies considered the emotional impact of built environments, showing a considerable gap in the studies simultaneously evaluating psychological and physical perspectives of Parkinson-friendly environments. There needs to be more consistency when considering these aspects of planning. Our findings suggest future research modeling enriched environments and tracking their impact on patients via Virtual Reality to find a comprehensive guideline for the most effective PD management environments.

An Umbrella Review of the Best and Most Up-to-Date Evidence on the Built Environment and Physical Activity in Older Adults ≥60 Years

Objectives: To present the best and most up-to-date evidence on associations between built environment (BE) attributes and overall and specific domains of physical activity (PA) (i.e., leisure, transport, walking, and cycling) in older adults (≥60 years).

Methods: An umbrella review was undertaken to compile evidence from systematic reviews using the Joanna Briggs Institute methodology. A comprehensive search (updated 16 August 2022), inclusion/exclusion of articles via title/abstract and full-text reviews, data extraction, and critical appraisal were completed. Only reviews with a good critical appraisal score were included.

Results: Across three included systematic reviews, each BE attribute category was positively associated with ≥1 PA outcome. A larger number of significant associations with BE attributes were reported for transport walking (13/26), total walking (10/25), and total PA (9/26), compared to leisure walking (4/34) and transport cycling (3/12). Fewer associations have been examined for leisure cycling (1/2).

Conclusion: Although the causality of findings cannot be concluded due to most primary studies being cross-sectional, these best and most up-to-date findings can guide necessary future longitudinal and experimental studies for the (re)design of age-friendly communities.

Macro-level literature analysis on pedestrian safety: Bibliometric overview, conceptual frames, and trends

Due to the high volume of documents in the pedestrian safety field, the current study conducts a systematic bibliometric analysis on the researches published before October 3, 2021, based on the science-mapping approach. Science mapping enables us to present a broad picture and comprehensive review of a significant number of documents using co-citation, bibliographic coupling, collaboration, and co-word analysis. To this end, a dataset of 6311 pedestrian safety papers was collected from the Web of Science Core Collection database. First, a descriptive analysis was carried out, covering whole yearly publications, most-cited papers, and most-productive authors, as well as sources, affiliations, and countries. In the next steps, science mapping was implemented to clarify the social, intellectual, and conceptual structures of pedestrian-safety research using the VOSviewer and Bibliometrix R-package tools. Remarkably, based on intellectual structure, pedestrian safety demonstrated an association with seven research areas: "Pedestrian crash frequency models", "Pedestrian injury severity crash models", "Traffic engineering measures in pedestrians' safety", "Global reports around pedestrian accident epidemiology", "Effect of age and gender on pedestrians' behavior", "Distraction of pedestrians", and "Pedestrian crowd dynamics and evacuation". Moreover, according to conceptual structure, five major research fronts were found to be relevant, namely "Collision avoidance and intelligent transportation systems (ITS)", "Epidemiological studies of pedestrian injury and prevention", "Pedestrian road crossing and behavioral factors", "Pedestrian flow simulation", and "Walkable environment and pedestrian safety". Finally, "autonomous vehicle", "pedestrian detection", and "collision avoidance" themes were identified as having the greatest centrality and development degrees in recent years.

Factors predicting gains in moderate-to-vigorous physical activity in prostate cancer survivors on androgen deprivation therapy

BACKGROUND

Whether individual, environmental, and psychosocial factors predict changes in moderate-to-vigorous physical activity (MVPA) is poorly addressed in prostate cancer (PC) survivors undergoing androgen deprivation therapy (ADT).

PURPOSE

This secondary analysis of a randomized controlled trial examined changes in MVPA following a supervised personal training (PT), supervised group-based (GROUP) program, or a home-based, smartphone-assisted exercise (HOME) intervention in PC survivors on ADT and explored individual, environmental, and psychosocial predictors of MVPA.

METHODS

PC survivors on ADT underwent aerobic and resistance training for 6 months via PT, GROUP, or HOME. MVPA was captured via accelerometers and the Godin Leisure-Time Exercise Questionnaire. Changes in MVPA between groups were assessed using linear regression. The following predictors of MVPA were examined using Spearman correlations: the Neighborhood Environment Walkability Scale (NEWS); the Planning, Attitudes, and Behaviours (PAB) scale; the Relatedness to Others in Physical Activity Scale (ROPAS); and individual factors at baseline.

RESULTS

Participants (n = 37) were 69.4 ± 6.5 years old and 78.4% were on ADT for ≥ 3 months. Changes in accelerometry-based bouts and MVPA as well as self-reported MVPA did not differ between groups at 6 months. The Aesthetics domain of the NEWS questionnaire at baseline was the strongest predictor of positive MVPA changes (r = .66). Attitude (r = .64), planning (r = .57), and motivation (r = .50) at baseline were also predictive of engaging in higher MVPA throughout the intervention.

CONCLUSION

Changes in objective MVPA were modest. Additional emphasis on specific psychosocial and individual factors is important to inform theory-based interventions that can foster PA behavior change in PC survivors on ADT. Registration # NCT02046837.

Predictors of change over time in satisfaction with outdoor activities ratings among long-term care services and supports recipients

OBJECTIVES

To identify predictors of change in older adults' satisfaction with outdoor activities ratings over the first two years of enrollment in long-term services and supports (LTSS).

METHODS

Self-rated satisfaction with outdoor activities (not at all satisfied to extremely satisfied) was the primary outcome of this secondary data analysis. Mixed-effects linear regression modeling with a backward elimination process was used for analyses.

RESULTS

In the final model (N = 453) older LTSS recipients at baseline had lower ratings of satisfaction with outdoor activities over time, whereas younger recipients had higher ratings over time. Those who moved into a residential facility at baseline had an increase in outdoor activity satisfaction ratings over time compared to older adults who received home and community-based services that had a decrease.

DISCUSSION

LTSS clinicians can use these findings to support older adults with decision-making around enrollment into LTSS, address preferences, and develop person-centered care interventions for outdoor activity.

Differences in the Correlation between the Built Environment and Walking, Moderate, and Vigorous Physical Activity among the Elderly in Low- and High-Income Areas

Studies have proved that activity and fitness behaviors are closely related to the quality of life and health status of the elderly. However, different intensities of physical activity (PA)—walking, moderate PA, and vigorous PA—have different correlations with the built environment (BE). This study combines the high and low socioeconomic status (SES) of Guangzhou to establish two types of BE models. The physical activity time of 600 elderly people was collected from questionnaires. Through ArcGIS software, 300 m, 500 m, 800 m, and 1000 m buffer zones were identified, and the land use diversity, street design, population density, distance to destination, distance to public transportation—the five Ds of the BE—were measured. SPSS software was adopted to analyze the correlation between the BE and PA. Results: The PA of people living in low-SES areas was more dependent on the BE, whereas the correlation may be limited in high SES areas. Moreover, in low SES areas, walking was negatively correlated with street connectivity; moderate PA was positively correlated with street connectivity and the shortest distance to the subway station, but negatively correlated with the density of entertainment points of interest (POIs). Studying the relevant factors of the environment can propose better strategies to improve the initiative of the elderly to engage in PA.

Dual task walking in healthy aging: Effects of narrow and wide walking paths

Dual-task walking may lead to gait instability and a higher fall risk in older adults, particularly when walking in a busy city street. Challenging street features such as narrow sidewalks not only discourage walking, but are also likely to be taxing for older adults’ cognitive resources and gait characteristics. The aim of this study was to assess the way older adults’ gait characteristics are affected by walking on a narrow path while performing a challenging cognitive task in lab conditions imitating common urban environments. Nineteen young and eighteen older adults walked on a narrow (40cm) and a wide (80cm) path and performed a cognitive (n-back) task individually adjusted to 80% accuracy. The two tasks were performed separately (Single-Task) and concurrently (Dual-Task). Both groups walked faster, and their step width was narrower on the narrow path. During dual-task walking on the narrow path, older adults showed significant dual-task costs in the cognitive task, gait speed, step width, and stride length. Dual-task walking was associated with decreased gait speed and stride length in both age groups, suggesting that dual-task walking may adversely affect gait, particularly when walking on narrow paths. These conditions may lead to gait instability and an increased fall risk for older adults, particularly when walking along the narrow sidewalks commonly found within the built environment. However, more research is needed in an urban setting to determine the extent of the fall risk narrow sidewalks present for older adults.

Investigating the fatal pedestrian crash occurrence in urban setup in a developing country using multiple-risk source model

Pedestrian fatalities and injuries are a major public health burden in developing countries. In the safety literature, pedestrian crashes have been modelled predominately using single equation regression models, assuming a single underlying source of risk factors. In contrast, the fatal pedestrian crash counts at a site may be an outcome of multiple sources of risk factors, such as poor road infrastructure, land use type, traffic exposures, and operational parameters, site-specific socio-demographic characteristics, as well as pedestrians' poor risk perception and dangerous crossing behavior, which may be influenced by poor road infrastructure and lack of information, etc. However, these multiple sources are generally overlooked in traditional single equation crash prediction models. In this background, this study postulates, and demonstrates empirically, that the total fatal pedestrian crash counts at the urban road network level may arise from multiple simultaneous and interdependent sources of risk factors, rather than one. Each of these sources may distinctively contribute to the total observed crash count. Intersection-level crash data obtained from the "Kolkata Police", India, is utilized to demonstrate the present modelling methodology. The three-components mixture model and a joint econometric model are developed to predict fatal pedestrian crashes. The study outcomes indicate that the multiple-source risk models perform significantly better than the single equation regression model in terms of prediction ability and goodness-of-fit measures. Moreover, while the single equation model predicts total fatal crash counts for individual sites, the multiple risk source model predicts crash count proportions contributed by each source of risk factors and predicts crashes by a particular source.

Cultural Sets Shape Adult Conceptualizations and Relationships to Nature

The variability of nature and the nature construct have complicated interpretations of empirical evidence from nature-based health studies. The challenge of defining nature exposure for purposes of methodological standardization may encompass constructs beyond vegetated landcover. This study offers a new construct for defining 'nature exposure' that considers cultural sets and nature familiarity. Focus group discussions across the United States (N = 126) explored the concept of what constitutes the relationship to nature. The participant diversity included regions, cultural demographics, cumulative nature experience, and everyday nature exposure. Mixed methods of semi-structured discussion and a photo exercise that prompted nature connectedness allowed for data triangulation and the detection of contradictions between approaches. Individuals conceptualized nature in ways reflecting highly personal and differentiated experiences, which defied consensus toward a single nature construct. The group scoring of photo imagery showed consistent high and low levels of nature connectedness with respect to wildness and outdoor urban venues, respectively, but diverged in the assessment of nature within the built environment. Everyday nature exposure significantly differentiated how groups conceptualized and related to nature imagery. This result may indicate an unmet biophilic need among groups with low backgrounds of nature exposure. The contrasts between the discussion content and the observed reactions to nature imagery showed the value of using mixed methods in qualitative research.

Investigating the practical viability of walk-sharing in improving pedestrian safety

Walk-sharing is a cost-effective and proactive approach that promises to improve pedestrian safety and has been shown to be technically (theoretically) viable. Yet, the practical viability of walk-sharing is largely dependent on community acceptance, which has not, until now, been explored. Gaining useful insights on the community's spatio-temporal and social preferences in regard to walk-sharing will ensure the establishment of practical viability of walk-sharing in a real-world urban scenario. We aim to derive practical viability using defined performance metrics (waiting time, detour distance, walk-alone distance and matching rate) and by investigating the effectiveness of walk-sharing in terms of its major objective of improving pedestrian safety and safety perception. We make use of the results from a web-based survey on the public perception on our proposed walk-sharing scheme. Findings are fed into an existing agent-based walk-sharing model to investigate the performance of walk-sharing and deduce its practical viability in urban scenarios.

Increased Use of Porch or Backyard Nature during COVID-19 Associated with Lower Stress and Better Symptom Experience among Breast Cancer Patients

Contact with nature has been used to promote both physical and mental health, and is increasingly used among cancer patients. However, the COVID-19 pandemic created new challenges in both access to nature in public spaces and in cancer care. The purpose of our study was to evaluate the change in active and passive use of nature, places of engaging with nature and associations of nature contact with respect to improvements to perceived stress and symptom experience among breast cancer patients during the pandemic. We conducted a cross-sectional survey of people diagnosed with breast cancer using ResearchMatch (n = 56) in July 2020 (the first wave of COVID-19). In this US-based, predominantly white, affluent, highly educated, female sample, we found that, on average, participants were first diagnosed with breast cancer at 54 years old and at stage 2 or 3. Eighteen percent of participants experienced disruptions in their cancer care due to the pandemic. As expected, activities in public places significantly decreased as well, including use of parks/trails and botanical gardens. In contrast, spending time near home, on the porch or in the backyard significantly increased. Also observed were significant increases in indoor activities involving passive nature contact, such as watching birds through a window, listening to birdsong, and smelling rain or plants. Decreased usage of parks/trails was significantly associated with higher stress (Coef = -2.30, p = 0.030) and increased usage of the backyard/porch was significantly associated with lower stress (Coef = -2.69, p = 0.032), lower symptom distress (Coef = -0.80, p = 0.063) and lower symptom severity (Coef = -0.52, p = 0.009). The most commonly reported alternatives to outdoor engagement with nature were watching nature through a window (84%), followed by looking at images of nature (71%), and listening to nature through a window (66%). The least commonly enjoyed alternative was virtual reality of nature scenes (25%). While outdoor contact with nature away from home decreased, participants still found ways to experience the restorative benefits of nature in and around their home. Of special interest in planning interventions was the fact that actual or real nature was preferred over that experienced through technology. This could be an artifact of our sample, or could represent a desire to be in touch with the "real world" during a health crisis. Nature contact may represent a flexible strategy to decrease stress and improve symptom experience among patients with cancer, particularly during public health crises or disruptions to cancer care.

Systematic Literature Review of Walkability and the Built Environment

Walking is the most sustainable form of transportation. It is the socially equitable, economically viable and environmentally friendly mode of transportation. However, transportation technology has caused the desertion of the pedestrian space due to excessively motorized transport. Consequently, the pedestrian environment has degraded. In many cities, the abandonment of the pedestrian space has created a socially unfriendly environment. Walkability is a measure of how friendly an area is to walk. In measuring walkability, several criteria are considered, which include inter alia, the quality of pedestrian facilities, roadway conditions, land use patterns, community support, security and comfort for walking. Findings from studies are mixed; some stated that improving the built environment does not encourage people to walk more; however, there are other studies that indicated otherwise. The aim of this paper is to review the built environment characteristics that promote walking. A literature review of studies that focused on walking, walkability, the built environment, pedestrian and urban design was conducted. This study has searched the electronic databases that intertwined with the Web of Science database. The choice was made due to the comprehensiveness of quality academic studies indexed in the database, thus providing reliable sources of body of work. The database integrates numerous sub-databases such as Web of Science Core Collection, Derwent Innovations Index, KCI Korean Journal Database, Russian Science Citation Index and SciELO Citation Index. The data are then thematically coded. The fields of urban planning, urban design, geography, transportation, sociology, and other related areas were included in the research. The result of this review offers evidence to the criteria that promote walking. The review found that three criteria are somewhat constant in promoting walking, namely, population and building density, land use and land use mixes, and safety. In short, by making an area perceived as safe with the presence of land use mixes and density are the best combination to create a walkable environment.

Satisfaction With Outdoor Activities Among Northeastern U.S. Newly Enrolled Long-Term Services and Supports Recipients

Older adults receiving long-term services and supports (LTSS) experience barriers to outdoor activities and satisfaction ratings with such experiences are not well understood. Our study used cross-sectional data (n = 329) to (a) examine whether those new to LTSS were satisfied with their outdoor activities and (b) describe the characteristics and factors associated with satisfaction levels. Self-report of satisfaction with outdoor activities was the outcome variable. Multivariable linear regression modeling of the outcome was conducted. Fifty-nine percent were satisfied with their outdoor activities. More depressive symptoms (p < .001) and higher cognitive functioning (p = .011) were associated with lower ratings. Higher self-rated physical health (p = .009) and more independence with activities of daily living (p = .022) were associated with greater satisfaction. Findings suggest an unmet need among four in 10 new recipients of LTSS (41%) related to their outdoor activities. LTSS interdisciplinary teams can use these findings to inform their assessments, develop person-centered care plans, and address barriers.

Feelings of safety during daytime walking: associations with mental health, physical activity and cardiometabolic health in high vacancy, low-income neighborhoods in Detroit, Michigan

INTRODUCTION

Individuals living in low-income neighborhoods have disproportionately high rates of obesity, Type-2 diabetes, and cardiometabolic conditions. Perceived safety in one's neighborhood may influence stress and physical activity, with cascading effects on cardiometabolic health.

METHODS

In this study, we examined relationships among feelings of safety while walking during the day and mental health [perceived stress (PSS), depression score], moderate-to-vigorous physical activity (PA), Body Mass Index (BMI), and hemoglobin A1C (A1C) in low-income, high-vacancy neighborhoods in Detroit, Michigan. We recruited 69 adults who wore accelerometers for one week and completed a survey on demographics, mental health, and neighborhood perceptions. Anthropometrics were collected and A1C was measured using A1CNow test strips. We compiled spatial data on vacant buildings and lots across the city. We fitted conventional and multilevel regression models to predict each outcome, using perceived safety during daytime walking as the independent variable of interest and individual or both individual and neighborhood-level covariates (e.g., number of vacant lots). Last, we examined trends in neighborhood features according to perceived safety.

RESULTS

In this predominantly African American sample (91%), 47% felt unsafe during daytime walking. Feelings of perceived safety significantly predicted PSS (β = - 2.34, p = 0.017), depression scores (β = - 4.22, p = 0.006), and BMI (β = - 2.87, p = 0.01), after full adjustment. For PA, we detected a significant association for sex only. For A1C we detected significant associations with blighted lots near the home. Those feeling unsafe lived in neighborhoods with higher park area and number of blighted lots.

CONCLUSION

Future research is needed to assess a critical pathway through which neighborhood features, including vacant or poor-quality green spaces, may affect obesity-via stress reduction and concomitant effects on cardiometabolic health.

Walking in Your Culture: A Study of Culturally Sensitive Outdoor Walking Space for Chinese Elderly Immigrants

OBJECTIVES

This was a study conducted in Atlanta, GA, in the United States with Chinese elderly immigrants, examining the relationship between visual preference and motivation to walk in a particular outdoor space.

BACKGROUNDS

Outdoor walking promotes the well-being of older adults. However, their declined body functions impact their motivation to walk outside. For elderly immigrants living in a country with different cultural backgrounds from their homelands, it is important to find the ways to enhance their motivation of outdoor walking.

METHOD

Visual preference survey was conducted to assess preferences of first-generation Chinese elderly immigrants attending a care facility setting. Preferences included Chinese classical walking spaces or American modern walking spaces. The data were interpreted using descriptive statistics and factorial experiment analysis.

RESULTS

A total of 95 Chinese elderly immigrants gave valid responses to the visual preference survey. Survey results revealed that respondents had a high preference for Chinese classical walking spaces even though they had an average time of 26 years as a U.S. resident. Although the functions and purposes of the walking spaces caused safety and comfort concerns, the interaction effects of design style, design function, and design purpose illustrated that Chinese classical style had high effectiveness to promote outdoor walking of Chinese elderly immigrants.

CONCLUSIONS

These results support the significance of culturally sensitive care environments in promoting outdoor walking for elderly Chinese immigrants. It also indicates that spaces designed with an assigned cultural style had higher attractiveness to older adults from the same assigned cultural background.

A systematic review of the evolution of GPS use in active living research: A state of the evidence for research, policy, and practice

This is the first systematic review to comprehensively capture Global Positioning Systems' (GPS) utilization in active living research by investigating the influence of physical contexts and social environment on all intensities of physical activity and sedentary behavior among all age groups. An extensive search of peer-reviewed literature was conducted using six databases. Out of 2026 articles identified, 129 studies met the inclusion criteria. After describing the evolution of GPS use across four themes (study designs and methods, physical contexts and social environment, active transportation, and behaviors), evidence-based recommendations for active living research, policy, and practice were generated.

The effects of exergaming on pain, postural control, technology acceptance and flow experience in older people with chronic musculoskeletal pain: a randomised controlled trial

BACKGROUND

Older people with chronic musculoskeletal pain are at risk of falls. This study aimed to investigate the effects of exergaming on pain and postural control in older people with chronic musculoskeletal pain. Secondary outcomes were technology acceptance, flow experience, perceived physical exertion, expended mental effort and heart rate.

METHODS

Fifty four older adults (age: 71 ± 5 years) with chronic musculoskeletal pain were randomised into 2 groups. Group 1 received exergaming training using the Interactive Rehabilitation and Exercise System (IREX®). Group 2 undertook traditional gym-based exercise (TGB). Both groups completed twice weekly 40-min exercise sessions for 6 weeks. Perceived pain was measured using a numeric pain rating scale and the Multidimensional Affect and Pain Survey questionnaire. Postural control was measured as sway using a Kistler™ force platform. Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology questionnaire and flow experience with the Flow State Scale. Physiological measures of perceived physical exertion, expended mental effort and heart rate were recorded during all sessions.

RESULTS

The exergaming group demonstrated significant reductions in pain intensity and thermal pain including a near significant approach in physical engagement in comparison to TGB group. Although no intervention effects on postural control were found, the exergaming group showed significant improvements in three sway measures (AP SD, ML SD and AP range) over time whereas significant improvements in ML range were found in the TGB group. Relating to technology acceptance, significant intervention effects on social influence and behavioural intention were found in the TGB group instead, although both groups demonstrated increases of acceptance over time. Regarding flow experience, concentration at task was significantly influenced in the TGB group and significant increases in flow variables over time were observed in both groups. Significant increases over time in perceived physical exertion and expended mental effort were found in both groups.

CONCLUSION

Our findings support the potential of exergaming to alleviate pain and improve balance in older people with chronic musculoskeletal pain. Both forms of exercise are acceptable, intrinsically motivating and show evidence of benefit to older people with chronic musculoskeletal pain.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04029285 (retrospectively registered, July 23, 2019).

The Role of Architecture and Design in the Management of Parkinson's Disease: A Systematic Review

Background:

Parkinson’s disease (PD) is a neurological condition characterized by the development of daily disabling symptoms. Although the architecture and design of a PD patient’s environment can hinder or facilitate full participation in daily activities, their putative role in the management of these patients has received little attention to date.

Objective:

We conducted a systematic review to evaluate the evidence of architectural and design features in the management of people with PD.

Methods:

An electronic database search of observational and experimental studies was conducted in MEDLINE and Embase from inception to May 2020, with two independent reviewers identifying the studies. Falls, fear of falling, postural instability, gait impairment/disability, and functional mobility were our outcomes of interest.

Results:

Thirty-six studies were included, among which nineteen were observational and seventeen were experimental studies (overall participants = 2,965). Pavement characteristics, notably unstable surfaces and level differences, were found to be a major cause of falling. Ground-based obstacles and confined/narrowed spaces were found to disturb gait, increase postural instability, and decrease functional mobility. Housing type did not appear to increase risk of falling, nor to significantly explain concerns about falling.

Conclusion:

Findings suggest a need to adjust architectural features of the surrounding space to ensure appropriate care and provide a safe environment to PD patients. More evidence about the impact of such modifications on PD outcomes is needed.

Important Elements and Features of Neighborhood Landscape for Aging in Place: A Study in Hong Kong

With rapid growth in the aging population around the world, the promotion of aging in place has become more significant in recent years. Many neighborhood landscape elements and features have been revealed by accumulating research findings to be critical to aging in place. However, they are usually studied separately or in small groups. Little has been done to examine the relative importance of these elements and features when brought together, from the older adult's point of view. In this context, the current study investigated the perceived importance for older adults of 22 selected neighborhood landscape elements and features. A questionnaire survey was conducted in 17 public rental housing estates in Hong Kong with proportions of older residents (aged 65 or above) between 20 and 40%. According to the 426 collected samples, older adults considered as highly important landscape elements and features that contribute to comfort and help them avoid hazards, such as good ventilation, protection from severe sunshine/rain, body support, and good hygiene, while elements were thought to potentially bring hazards while not being necessities for older adults' outdoor experience were considered least important, including portable chairs, outdoor tables, plants that can be touched, closeness to children's playgrounds, small spaces for solitude, water features, and fitness equipment. After integrally interpreting the findings regarding perceived importance with other collected data, some landscape design suggestions are generated to supplement existing guidelines and recommendations concerning older adults' well-being and quality of life. These findings can inspire future research and landscape design that prioritize promoting aging in place.

A socio-spatial analysis of pedestrian falls in Aotearoa New Zealand

Falls are a leading cause of injury and accidental death, particularly amongst older people. Evidence of environmental risk factors for pedestrian falls among older adults could support age-friendly urban design and contribute to efforts to reduce the incidence of pedestrian falls and support outdoor mobility among older adults. Yet investigation of the environment in which pedestrian falls occur is often hampered by its reliance on participant recall and self-report information. We identified the point locations of falls occurring on the road or street among adults that were attended by an ambulance in New Zealand over a two-year period (2016-2018) and connected these to a range of social (e.g. deprivation) and environmental (e.g. slope, greenspace) risk factors. Three types of analysis were used: a descriptive analysis of fall rates, logistic regression assessing whether a patient was transported to hospital following a fall, and a negative binomial regression analysis of the pedestrian falls by small area. We found a number of differences in the built environment surrounding fall locations between age groups. Compared with younger age groups, older adults showed high fall rates closer to home, and higher fall rates in areas with many types of destinations nearby. Additionally, our results showed a higher rate of pedestrian falls in more deprived areas. People who live in more deprived areas also fell over more frequently, but the pattern is stronger based on deprivation at the fall location, rather than home location. Residents of more deprived areas were less likely to be transported to hospital following a fall. Thus, our findings have equity implications for both environments and patient experience. These patterns could not have been identified without the novel use of spatially specific fall data.

How Does Walkability Change Behavior? A Comparison between Different Age Groups in the Netherlands

Empirical research provides evidence that, in neighborhoods with higher walkability, individuals make more walking trips. However, it is not clear what the exact nature is of the relationships between neighborhood walkability and walking trips, since a higher walking frequency can be explained in different ways. This study examined whether the extra walking trips in better walkable neighborhoods are related primarily to trip generation, destination choice, or transport mode choice and whether this is the same for different age groups. A neighborhood fixed effects regression analysis was conducted in a first step to obtain a walkability measure for each neighborhood in the Netherlands including systematic as well as unobserved effects. Subsequently, the estimated fixed effects were used as walkability data for a path analysis based on a causal model to test the hypotheses stated. The results of the path analysis show direct relationships of neighborhood walkability with trip generation, destination choice, and transport mode choice, after controlling for the mutual relationships between the activity and trip variables. Comparing different age groups (i.e., children, adults, and elderly), the differences found mostly concerned the relationship between neighborhood walkability and trip generation. We concluded therefore that conditions for walkability are not the same for all age groups.

How Does Walkability Change Behavior? A Comparison between Different Age Groups in the Netherlands

Empirical research provides evidence that, in neighborhoods with higher walkability, individuals make more walking trips. However, it is not clear what the exact nature is of the relationships between neighborhood walkability and walking trips, since a higher walking frequency can be explained in different ways. This study examined whether the extra walking trips in better walkable neighborhoods are related primarily to trip generation, destination choice, or transport mode choice and whether this is the same for different age groups. A neighborhood fixed effects regression analysis was conducted in a first step to obtain a walkability measure for each neighborhood in the Netherlands including systematic as well as unobserved effects. Subsequently, the estimated fixed effects were used as walkability data for a path analysis based on a causal model to test the hypotheses stated. The results of the path analysis show direct relationships of neighborhood walkability with trip generation, destination choice, and transport mode choice, after controlling for the mutual relationships between the activity and trip variables. Comparing different age groups (i.e., children, adults, and elderly), the differences found mostly concerned the relationship between neighborhood walkability and trip generation. We concluded therefore that conditions for walkability are not the same for all age groups.

The effects of small-scale physical and social environmental interventions on walking behaviour among Dutch older adults living in deprived neighbourhoods: results from the quasi-experimental NEW.ROADS study

PURPOSE

Improving the physical and social conditions of residential neighbourhoods may increase walking, especially among older people. Evidence on the effects of physical and social environmental interventions, and particularly the combination of both, on walking behaviour is scarce. We evaluated the effects of a small-scale physical environmental intervention (designated walking route), a social environmental intervention (neighbourhood walking group) and the combination of both on walking behaviour of older adults living in deprived neighbourhoods.

METHODS

Survey data of 644 older adults residing in four deprived neighbourhoods of Rotterdam, the Netherlands, were used to compare changes in walking behaviour over time (weekly minutes spent recreational walking, utilitarian walking and total walking) of those exposed to 1) a designated walking route (physical condition), 2) walking groups (social condition), 3) walking routes and walking groups (combined condition), and 4) no intervention (control condition). Measurements took place at baseline (T0), and 3 months (T1) and 9 months (T2) after the intervention. Data were analysed on a multiple imputed dataset, using multi-level negative binomial regression models, adjusting for clustering of observations within individuals. All models were adjusted for demographic covariates.

RESULTS

Total time spent walking per week increased between T0 and T1 for all conditions. The Incidence Rate Ratio (IRR) for the physical condition was 1.46 (95% CI:1.06;2.05) and for the social intervention 1.52 (95%CI:1.07;2.16). At T2, these differences remained significant for the physical condition, but not for the social condition and the combined condition. These findings were mirrored for utilitarian walking. No evidence was found for an effect on recreational walking.

CONCLUSION

Implementing small scale, feasible, interventions in a residential neighbourhood may increase total and utilitarian walking behaviour among older adults.

The neighborhood social environment and physical activity: a systematic scoping review

BACKGROUND

Investigating the association of the neighborhood social environment on physical activity is complex. A systematic scoping review was performed to (1) provide an inventory of studies assessing the influence of the neighborhood social environment on physical activity since 2006; (2) describe methodologies employed; and (3) formulate recommendations for the field.

METHODS

Two databases were searched using terms related to 'physical activity,' 'neighborhood,' and 'social environment' in January 2017. Eligibility criteria included: 1) physical activity as an outcome; 2) neighborhood social environment as a predictor; 3) healthy population (without diagnosed clinical condition or special population); 4) observational or experimental design. Of 1352 studies identified, 181 were included. Textual data relevant to the social environment measurement and analysis were extracted from each article into qualitative software (MAXQDA) and coded to identify social environmental constructs, measurement methods, level of measurement (individual vs. aggregated to neighborhood), and whether authors explicitly recognized the construct as the social environment. The following measures were generated for each construct: number of unique measurements; % of times measured at an aggregate level; % of times authors referred to the construct as the social environment. Social environmental constructs were then grouped into larger descriptive dimensions.

RESULTS/FINDINGS

Fifty-nine social environmental constructs were identified and grouped into 9 dimensions: Crime & Safety (n = 133 studies; included in 73% of studies); Economic & Social Disadvantage (n = 55, 33%); Social Cohesion & Capital (n = 47, 26%); Social Relationships (n = 22, 12%); Social Environment (n = 16, 9%); Disorder & Incivilities (n = 15, 8%); Sense of Place/Belonging (n = 8, 4%); Discrimination/Segregation (n = 3, 2%); Civic Participation & Engagement (n = 2, 1%). Across all articles, the social environment was measured using 176 different methods, was measured at an aggregate-level 38% of the time, and referred to as the social environment 23% of the time.

CONCLUSIONS

Inconsistent terminology, definitions, and measurement of the social environment and the lack of explicit language identifying constructs as the social environment make it challenging to compare results across studies and draw conclusions. Improvements are needed to increase our understanding of social environmental correlates and/or determinants of physical activity and facilitate cross-disciplinary conversations necessary to effectively intervene to promote physical activity.

TRIAL REGISTRATION

PROSPERO CRD42017059580.

Measuring Neighborhood Order and Disorder: a Rapid Literature Review

PURPOSE OF REVIEW

Neighborhood disorder has received attention as a determinant of health in urban contexts, through pathways that include psychosocial stress, perceived safety, and physical activity. This review provides a summary of data collection methods, descriptive terms, and specific items employed to assess neighborhood disorder/order.

RECENT FINDINGS

The proliferation of methods and terminology employed in measuring neighborhood disorder (or neighborhood order) noted over the past two decades has made related studies increasingly difficult to compare. Following a search of peer-reviewed articles published from January 1998 to May 2018, this rapid literature review identified 18 studies that described neighborhood environments, yielding 23 broad terms related to neighborhood disorder/order, and a total of 74 distinct measurable items. A majority of neighborhood disorder/order measurements were assessed using primary data collection, often relying on resident self-report or investigatory observations conducted in person or using stored images for virtual audits. Items were balanced across signs of order or disorder, and further classification was proposed based on whether items were physically observable and relatively stable over time.

Older Adults' Outdoor Walking and Inequalities in Neighbourhood Green Spaces Characteristics

Outdoor walking has considerable benefits for healthy ageing and older adults are recommended to walk regularly. However, older adults living in high-deprivation areas walk less than those living in low-deprivation areas. Previous research has shown that the characteristics of neighbourhood green spaces (i.e., proximity, attractiveness, size, and number) may influence outdoor walking. This study examines spatial inequalities in the characteristics of neighbourhood green spaces in high- versus low-deprivation areas and their possible influences on disparities in older adults’ outdoor walking levels. For this purpose, it included a sample of 173 participants (≥65 years) and used secondary data and a geographic information system (GIS) to objectively measure neighbourhood green spaces characteristics. Geographic positioning system (GPS) technology was used to objectively measure outdoor walking levels. Data on participants’ personal characteristics were collected by questionnaire. The results indicate that one characteristic of neighbourhood green spaces (i.e., size) is positively related to outdoor walking levels. They show that inequalities in neighbourhood green spaces’ size in high- versus low-deprivation areas may influence disparities in older adults’ outdoor walking levels. Despite inequalities in other neighbourhood green space characteristics (e.g., proximity, attractiveness, and number) in high- versus low-deprivation areas, no relationship was found between these neighbourhood green space characteristics and participants’ outdoor walking levels. Enhancing the distribution or creation of large neighbourhood green spaces (e.g., through creating green space networks) may enhance outdoor walking among older residents, especially in high-deprivation areas.

The planning and reporting of mixed methods studies on the built environment and health

Researchers examining the influence of the built environment on health are increasingly using mixed methods approaches. The use of more than one type of methodology to address a single research question is compelling in this field because researchers investigating the impact of the built environment on health have been faced with proposing solutions to a complex societal problem involving interacting systems and social uncertainties. Mixed methods studies can help researchers to gain a better understanding of the relationships that exist between humans and their environment by drawing on qualitative and quantitative methods. Mixed methods studies could also be instrumental for providing effective policy solutions. This is because they allow researchers to identify built environment determinants of health in a population of interest and to understand the social and cultural factors that might influence the uptake of an intervention by this population. The objective of this paper is to assist those conducting research on the built environment and health who may have little background in mixed methods. We provide an overview of mixed methods research designs and provide concrete techniques for the integration of diverse methods. We also discuss the recommendations for mixed methods research in the field of built environment - health research, drawing on specific examples from published studies. Reporting a research design and an integration strategy in mixed methods studies could help to strengthen our ability to gain new insights into the multidimensional nature of the relationship between the built environment and health.

Environmental Factors Associated with Older Adult’s Walking Behaviors: A Systematic Review of Quantitative Studies

The aim of this study is to systematically review the relationship between neighborhood environments and all types of walking behaviors among older adults. Seventy peer-reviewed journal articles which met the selection criteria were examined. Research designs were summarized by geographical location and the associations of environmental characteristics and walking were calculated. Interactions between moderators and environmental characteristics for all types of walking were also categorized. Results have shown that transport walking is the most supported by neighborhood environmental characteristics. The positively related environmental characteristics are walkability, urbanization, land use mix-diversity and accessibility, walking amenities, and bicycle lanes. Total walking was positively associated with walkability and urbanization. Recreational walking was associated with neighborhood employment/income level, nearness to public transport/bus stops, and social cohesion. The most commonly used moderators were age and gender, but inconsistent moderating effects between neighborhood environments and walking were also found. In densely populated environments such as Hong Kong, older adults walked mostly for both transport and recreation. In contrast, American older adults in low density areas walked less for transport and more for recreation. Findings support a strong relationship between neighborhood environments and older adults’ walking. Future research should focus on longitudinal studies and comparison studies by geographic location.

"I Would Never Come Here Because I've Got My Own Garden": Older Adults' Perceptions of Small Urban Green Spaces

Green spaces are known to improve health and wellbeing via several mechanisms, such as by reducing stress and facilitating physical activity. However, little is known about the impact of the smaller green spaces typically found in urban environments on wellbeing, especially for older adults. This study investigated experiences in adults (5 males and 10 females) aged 60 years and over of small urban green spaces in a large UK city. Fifteen older adults were interviewed using semi-structured walk-along interviews and photo elicitation methods in Old Moat, Greater Manchester. Twelve of the participants lived in Old Moat at the time of the study, and the remaining three participants previously lived in Old Moat and were frequent visitors. Transcribed interviews were analyzed using Thematic Analysis. Smaller urban green spaces were perceived differently to large green spaces, and participants were more likely to use larger green spaces such as parks. The smaller green spaces were perceived as belonging to other people, which discouraged the older adults from using them. The older adults also emphasized the importance of taking care of small urban green spaces and preventing them from becoming overgrown. Urban planners should consider these factors, since they indicate that the size and type of urban green spaces may influence whether they improve health and wellbeing. Further research should investigate in more detail which types of urban green space are most conducive to facilitating physical activity and improving wellbeing.

Mobile Sensing in Environmental Health and Neighborhood Research

Public health research has witnessed a rapid development in the use of location, environmental, behavioral, and biophysical sensors that provide high-resolution objective time-stamped data. This burgeoning field is stimulated by the development of novel multisensor devices that collect data for an increasing number of channels and algorithms that predict relevant dimensions from one or several data channels. Global positioning system (GPS) tracking, which enables geographic momentary assessment, permits researchers to assess multiplace personal exposure areas and the algorithm-based identification of trips and places visited, eventually validated and complemented using a GPS-based mobility survey. These methods open a new space-time perspective that considers the full dynamic of residential and nonresidential momentary exposures; spatially and temporally disaggregates the behavioral and health outcomes, thus replacing them in their immediate environmental context; investigates complex time sequences; explores the interplay among individual, environmental, and situational predictors; performs life-segment analyses considering infraindividual statistical units using case-crossover models; and derives recommendations for just-in-time interventions.

Location monitoring of physical activity and participation in community dwelling older people: a scoping review

Background: Community participation and physical activity are important for the health of older adults. This review aimed to identify studies which have measured physical activity and community participation in older adults using Global positioning systems.Materials and methods: This scoping review searched key databases using predetermined subject headings and keywords. Two independent reviewers selected studies based on a systematic procedure following current guidelines. Inclusion criteria for studies were: participants aged over 50 years living independently in the community that reported on physical activity and/or participation inclusive of physical and social activity, and including a quantitative measure of location. All searches were limited to English. The primary review question was; "What studies have monitored the location of physical activity in an older population?" with secondary enquiries investigating the types of global positioning system devices, barriers and facilitators for activity and community participation.Results: The search returned 3723 articles (following duplicate removal) and 45 met the inclusion criteria. Studies from 12 countries published over a 12-year period were included. Participants were mainly healthy (n = 23) followed by having a cognitive impairment (n = 10). There were 14 different global positioning system devices used, assessing a variety of outcomes (n = 24). Seventeen studies identified facilitators and barriers to participation and physical activity in an older population. The most common facilitators were safety, weather and access to multi-purpose facilities. The most common barriers were weather, safety, low income/high deprivation areas and use of motor vehicles.Conclusion: This scoping review identified a variety of locational monitoring of older people using global positioning devices. Global positioning systems are a valuable tool to obtain accurate activity locations of older people. There is a need for clear guidelines regarding the use of global positioning system devices and specified outcomes in primary research to enable comparison across studies.Implications for rehabilitationPhysical activity and community participation are vital for healthy ageing.The environment can act as a facilitator or barrier to physical activity and community participation for older adults.Interventions need to target facilitators (weather, safety, facility access and social components) to maximize physical activity and community participation in older people.Interventions should be designed to reduce the barriers (weather, safety, low income and motor vehicle dependency) that prevent older adults from actively participating in their community.

Fear of Outdoor Falling Among Community-Dwelling Middle-Aged and Older Adults: The Role of Neighborhood Environments

Background and Objectives

Fear of falling is a substantial barrier to walking and has been associated with increased fall risks. This study examines neighborhood environmental risk factors related to fear of outdoor falling in middle-aged and older adults.

Research Design and Methods

A total of 394 participants aged 50 years or older living independently in the community were recruited between 2013 and 2014 from an integrated health care network serving Central Texas. Fear of outdoor falling and perceived neighborhood environmental variables were assessed using self-reported questionnaires. Logistic regression identified perceived neighborhood environmental variables associated with fear of outdoor falling.

Results

Sixty-nine (17.9%) of 385 participants reported having a fear of outdoor falling. Compared to those who did not report a fear of outdoor falling, those who reported having a fear of outdoor falling were more likely to be adults aged 65 years or older (odds ratio [OR] = 2.974, 95% confidence interval [CI] = 1.247-7.094), be female (OR = 4.423, 95% CI = 1.830-10.689), have difficulty with walking for a quarter of a mile (OR = 2.761, 95% CI = 1.124-6.782), and have had a fall in the past year (OR = 4.720, 95% CI = 1.472-15.137). Among the neighborhood environmental characteristics examined, low traffic speed on streets (OR = 0.420, 95% CI = 0.188-0.935), drainage ditches (OR = 2.383, 95% CI = 1.136-5.000), and broken sidewalks (OR = 3.800, 95% CI = 1.742-8.288) were associated with the odds of having a fear of outdoor falling.

Discussion and Implications

In addition to the individual factors, findings from this study suggest the importance of addressing the environmental risk factors in identifying and reducing fear of outdoor falling among middle-aged and older adults.

How Well Do Seniors Estimate Distance to Food? The Accuracy of Older Adults' Reported Proximity to Local Grocery Stores

(1) Background: Findings from observational studies of relations between neighborhood environments and health outcomes underscore the importance of both objective and perceived experiences of those environments. A clearer understanding of the factors associated with discrepancies between these two assessment approaches is needed to tailor public health interventions to specific populations. This study examined how individual and neighborhood characteristics affect perceptions of supermarket distance, particularly when perceptions do not match objective measures. (2) Methods: Participants were older adults (n = 880) participating in the Senior Neighborhood Quality of Life Study in the Seattle/King County, WA or Baltimore/Washington, DC regions. Two main analyses were conducted. The primary outcome for Analysis I was participants’ geographic information systems (GIS)-based objective network distance to the closest supermarket. Generalized linear mixed models with block group-level random effects were used to assess associations between objective supermarket distance and individual/neighborhood characteristics. The primary outcome for Analysis II was a categorical “accuracy” variable, based on participants’ perceived distance to the nearest supermarket/grocery store relative to the objective distance, assuming a walking speed of 1.0 m/s. Multivariate log-linear models fit neural networks were used to assess influential covariates. (3) Results: Several significant associations with objective distance to the nearest supermarket were observed, including a negative relationship with body mass index (BMI) (95% CI = −45.56, −0.23), having walked to the supermarket in the last 30 days (−174.86, −59.42), living in a high-walkability neighborhood, and residing in Seattle/King County (−707.69, −353.22). In terms of participants’ distance accuracy, 29% were classified as accurate, 33.9% were “Underestimators”, 24.0% “Overestimators”, and 13.2% responded “Don’t Know”. Compared to Accurate participants, Overestimators were significantly less likely to have walked to the supermarket in the last 30 days, and lived objectively closer to a supermarket; Underestimators perceived significantly higher pedestrian safety and lived objectively further from a supermarket; and Don’t Know were more likely to be women, older, not living independently, and not having recently walked to the supermarket. (4) Conclusions: Both modifiable and nonmodifiable factors influence the accuracy of older adults’ perceptions of their proximity to the nearest supermarket. Recent experience in walking to the closest supermarket, along with personal safety, represent potentially modifiable perceived environmental factors that were related to older adults’ accuracy of perceptions of their neighborhood food environment.

Older people's experiences of everyday travel in the urban environment: a thematic synthesis of qualitative studies in the United Kingdom

Compared to younger age groups, older people spend more time in their locality and rely more heavily on its pedestrian and public transport infrastructure. Qualitative studies provide unique insight into people's experiences. We conducted a qualitative evidence synthesis of United Kingdom-based studies of older people's experiences of travelling in the urban environment. We searched health, social science, age-related and transport-related databases from 1998 to 2017. Fourteen papers (from 12 studies) were included in a thematic synthesis, a three-staged process that moves iteratively between codes, descriptive themes and cross-cutting analytical themes. Emerging themes were discussed with policy advisers. Four overarching themes were identified. The first and second theme pointed to the importance of ‘getting out’ and of being independent travellers. The third and fourth themes highlighted how local environments and travel systems enabled (or prevented) older people from realising these valued dimensions of travel. The loss of local amenities and micro-environmental features, such as pavement quality, personal safety and aesthetic appearance, were recurrent concerns. Free modes of travel like walking and bus travel were highly valued, including the social engagement they facilitated. Our review suggests that, while its extrinsic value (reaching destinations) matters, the intrinsic value of travel matters too. The process of travel is experienced and enjoyed for its own sake, with older people describing its contribution to their wellbeing.

What If Healthy Aging Is the 'New Normal'?

We dedicate this special issue to our colleague, Dr. Lucinda Bryant (1941-2016).[...].

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

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