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

Neighborhood racial income inequality and cognitive health

INTRODUCTION

Neighborhood socioeconomic status (SES) has been linked to dementia, but the distribution of SES within a neighborhood may also matter.

METHODS

Data from 460 (47% Black, 46% White) older adults from the Michigan Cognitive Aging Project were linked to census tract-level data from the National Neighborhood Data Archive (NaNDA). Neighborhood SES included two composites reflecting disadvantage and affluence. Neighborhood racial income inequality was the ratio of median incomes for White versus Black residents. Generalized estimating equations examined associations between neighborhood factors and cognitive domains.

RESULTS

Neighborhood racial income inequality was uniquely associated with worse cognitive health, and these associations did not differ by participant race. Neighborhood disadvantage was only associated with worse cognitive health among Black participants.

DISCUSSION

Both the level and racial distribution of SES within a neighborhood may be relevant for dementia risk. Racial differences in the level and impact of neighborhood SES contribute to dementia inequalities.

HIGHLIGHTS

Black participants lived in neighborhoods with lower socioeconomic status (SES) than White participants, on average. Neighborhood SES and racial income inequality were associated with worse cognition. Effects of neighborhood racial income inequality did not differ across racial groups. Effects of neighborhood SES were only evident among Black participants.

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.

Long-term Care Insurance and Health and Perceived Satisfaction of Older Chinese: Comparisons Between Urban/Rural Areas, Chronic Conditions, and Their Intersectionality

BACKGROUND

Evidence of the impact of long-term care insurance (LTCI) on health and well-being has predominantly come from developed countries. China officially launched its city-level LTCI policy in 2016. Recent evidence in China has shown that having an LTCI program contributes to positive health. However, it is unclear whether such positive policy effects were attributed to policy announcement or implementation effects, and whether the policy effects vary by locality, chronic conditions, and their intersectionality. This study examines whether there are longitudinal health benefits for older Chinese who are participating in LTCI, particularly considering their city location (urban/rural), whether they have chronic conditions, and the intersectionality.

METHODS

Following the Andersen Behavioral Model, health and satisfaction outcomes of 9253 adults aged 60+ years were extracted from the 2015 and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). Individual data were linked to census socioeconomic data with city-level characteristics and LTCI policy variable. Multilevel lagged regression models investigated the impact of LTCI policy on health and satisfaction with health services, after controlling for baseline individual- and city-level covariates.

RESULTS

Of 125 cities in the dataset, 21 (16.8%) had adopted LTCI. These city inhabitants had significantly better self-rated health and higher satisfaction relative to cities without LTCI policies when environmental- and personal-level characteristics were modeled. Health benefits of LTCI were stronger after policy announcement and were particularly observed among rural older adults and those with chronic conditions. Results also suggest that LTCI's positive effects on satisfaction spill over to middle-aged adults.

CONCLUSION

Expanding coverage and eligibility to LTCI for all older Chinese could improve health and well-being.

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.].

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.