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Neighborhood Social Capital and Achieved Mobility of Older Adults
Abstract
Evaluate associations of neighborhood social capital and mobility of older adults.
A community-based survey (Philadelphia, 2010) assessed mobility (Life-Space Assessment [LSA]; range = 0-104) of older adults (n = 675, census tracts = 256). Social capital was assessed for all adults interviewed from 2002-2010 (n = 13,822, census tracts = 374). Generalized estimating equations adjusted for individual- and neighborhood-level characteristics estimated mean differences and 95% confidence intervals (CIs) in mobility by social capital tertiles. Interactions by self-rated health, living arrangement, and race were tested.
Social capital was not associated with mobility after adjustment for other neighborhood characteristics (mean difference for highest versus lowest tertile social capital = 0.79, 95% CI = [-3.3, 4.8]). We observed no significant interactions. In models stratified by race, Black participants had higher mobility in high social capital neighborhoods (mean difference = 7.4, CI = [1.0, 13.7]).
Social capital may not contribute as much as other neighborhood characteristics to mobility. Interactions between neighborhood and individual-level characteristics should be considered in research on mobility.
© The Author(s) 2014.
... Poor street [257,289] and sidewalk characteristics [256,266,289]; poor perception of crime safety [202] and neighbour crime rates [290]; and, lack of benches [290] were associated with poor self-reported community mobility (e.g. poor LSA scores). ...
... Poor street [257,289] and sidewalk characteristics [256,266,289]; poor perception of crime safety [202] and neighbour crime rates [290]; and, lack of benches [290] were associated with poor self-reported community mobility (e.g. poor LSA scores). ...
... Self-reported outcomes. Studies reported that seeing others while walking [263], more contact with neighbours, neighbours social support and community volunteering [312]; participation in social activities and presence of personal assistance [262]; having a dog [265]; people being active [254]; greater social network scores [45]; greater social ties [139]; high social cohesion [126,146,202,259,313]; high density of place of employment in the neighbourhood [247]; higher area of socioeconomic status [199,253]; and, high social capital [290] were positively associated with better self-reported community walking outcomes. Two articles reported that social environment (unspecified) was positively associated with better selfreported community walking outcomes [254,273]. ...
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:
Due to 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 one article. Qualitative data were synthesized using content analysis.
Results:
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 impact of some environmental factors (e.g., number and type of street connections) and the role of gender on older adults' walking outcomes. We have provide a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specifc context, population or other forms of mobility, for example driving.
... People with FM who have severe depressive symptoms report increased pain and fatigue intensity, poorer sleep quality, greater overall severity of the disease and a greater impairment of the emotional aspects of health-related quality of life (HRQL) than people with FM with mild depressive symptoms 7,8 . Recent studies have found relationships between physical environment and disability [9][10][11][12][13] . Socioeconomic condition and neighborhood characteristics seemed to impact functioning and quality of life (QoL) regardless of individual characteristics 9,10 . ...
... Socioeconomic condition and neighborhood characteristics seemed to impact functioning and quality of life (QoL) regardless of individual characteristics 9,10 . As for the physical environment, characteristics such as social connectivity, sidewalk and street quality and house accessibility were negatively associated with disability 11,12 . Therefore, the worse the environmental conditions, the greater the level of disabilities 13 . ...
BACKGROUND AND OBJECTIVES: Fibromyalgia is characterized by diffuse pain, which may compromise the self-rated quality of life (SRQoL). Little is known about the influence of psychosocial and environmental factors on SRQoL in women with fibromyalgia. The objective was to investigate factors related to SRQol among women with fibromyalgia, according to International Classification of Functioning domain. METHODS: A cross-sectional population-based study was performed with 1,557 women. Those who self-reported fi-bromyalgia answered the Fibromyalgia Impact Index. SRQoL was evaluated by questions ranging from 1 (unsatisfied) to 3 (very satisfied). Exposures included personal and environmental factors distributed in four blocks according to hypothesized influence on outcome. Multiple linear regression was performed , considering 95% of confidence interval, using IBM SPSS version 24. RESULTS: Income sufficiency was related to higher SRQoL in model 1. Physical environment was related to SRQoL in model 2, 3 and 4. Functional capacity measurement was related to SR-QoL in model 4. In the final model, only depressive symptoms (ß:-0.374; CI:-0.037/-0.004) and number of painful body areas (ß: 0.204; CI:-0.102/-0.001) remained significantly related to SRQoL, explaining 27% of the variance. CONCLUSION: SRQoL was related to depressive symptoms and number of painful body areas even after controlled by so
... Pessoas com FM que apresentam sintomas depressivos graves relatam aumento da dor e intensidade da fadiga, pior qualidade de sono, maior gravidade geral da doença e maior comprometimento dos aspectos emocionais da qualidade de vida relacionada à saúde (QVRS) do que as pessoas com FM com sintomas depressivos leves 7,8 . Estudos recentes encontraram relações entre o ambiente físico e incapacidade [9][10][11][12][13] . A condição socioeconômica e as características de vizinhança pareciam impactar o funcionamento e a QV, independentemente das características individuais 9,10 . ...
... A condição socioeconômica e as características de vizinhança pareciam impactar o funcionamento e a QV, independentemente das características individuais 9,10 . Quanto ao ambiente físico, características como a conectividade social, qualidade da calçada e da rua e acessibilidade da casa foram associadas negativamente à incapacidade 11,12 . Portanto, quanto piores forem as condições ambientais, maior será o nível de incapacidades 13 . ...
BACKGROUND AND OBJECTIVES
Fibromyalgia is characterized by diffuse pain, which may compromise the self-rated quality of life (SRQoL). Little is known about the influence of psychosocial and environmental factors on SRQoL in women with fibromyalgia. The objective was to investigate factors related to SRQol among women with fibromyalgia, according to International Classification of Functioning domain.
METHODS
A cross-sectional population-based study was performed with 1,557 women. Those who self-reported fibromyalgia answered the Fibromyalgia Impact Index. SRQoL was evaluated by questions ranging from 1 (unsatisfied) to 3 (very satisfied). Exposures included personal and environmental factors distributed in four blocks according to hypothesized influence on outcome. Multiple linear regression was performed, considering 95% of confidence interval, using IBM SPSS version 24.
RESULTS
Income sufficiency was related to higher SRQoL in model 1. Physical environment was related to SRQoL in model 2, 3 and 4. Functional capacity measurement was related to SRQoL in model 4. In the final model, only depressive symptoms (ß:-0.374; CI: -0.037/ -0.004) and number of painful body areas (ß: 0.204; CI: -0.102/-0.001) remained significantly related to SRQoL, explaining 27% of the variance.
CONCLUSION
SRQoL was related to depressive symptoms and number of painful body areas even after controlled by socioeconomic, environment and health status. However, other aspects may mediate or moderate that outcome, deserving attention in a biopsychosocial approach. The results highlighted the relevance of biopsychosocial aspects on quality of life of women with fibromyalgia, addressing factors that could be approached in clinical practice to promote health and well-being.
... In addition, neighbourhoods characterized by good street connectivity, land-use mix, and residential density are more conducive to walking (King et al., 2011;Lynott et al., 2009;Turrell et al., 2013;Villanueva et al., 2014). Neighbourhood social capital and social engagement have been linked to mobility in later life (Gardner, 2014;Rosso, Tabb, Grubesic, Taylor, & Michael, 2014). Finally, mobility is influenced by individual characteristics such as gender, health status, age, and socioeconomic status (Lynott et al., 2009). ...
... This suggests that the connection between mobility and social interactions would further influence older adults with mobility limitations. Mobility as a mean for social interactions in later life has recently caught the interests of researchers but needs to be further explored (Cerin et al., 2017;Chaudhury et al., 2012;Gardner, 2014;Gardner, 2011;Hanson et al., 2012;Rosso et al., 2014;Rosso, Taylor, Tabb, & Michael, 2013;Van Holle et al., 2016). ...
The majority of Canada’s older adults want to “age in place” in their home and community as long as possible, even in the face of declining health and physical functioning. Cohousing and Naturally Occurring Retirement Communities (NORC) have been identified as potential aging in place phenomenon. However, empirical research on both communities in Canada is either scarce or nonexistent. A multiple-case study design was used to gain an understanding of the influence of the physical and social environment of residential settings and neighbourhoods on aging in place processes among older adults in cohousing and NORC. Twenty (20) older adults living in cohousing or NORC in British Columbia, Canada were recruited to conduct photovoices and semi-structured interviews. Data was collected and analyzed following constructivist grounded theory methodology. Findings show that aging in place processes were influenced by interacting factors found at multiple levels. At the individual and psychosocial level, aging in place was influenced by older adults’ health status, functional ability, mobility capacity, agency, resilience, and feeling of safety. At the physical environment level, associations with accessibility, functionality, neighbourhood destinations, and aesthetics were found. At the social environment level, aging in place was linked to community engagement, mutual support, meaningful social connections, and the social fabric of the neighbourhood. In addition, mobility was central to participants’ experience of place. Based on these findings, a conceptual framework on aging in place is proposed to better explain the complex dynamics between older adults and the physical and social environments of the neighbourhood. The integrated analysis of the residential and neighbourhood environments highlighted the relevance of considering “place” in aging as a continuum of various geographical scales in future research. This study documents, for the first time in Canada, the experience of older adults living in NORC and cohousing communities. In which manner these communities may provide an optimal environment for aging in place needs to be further documented. A copy can also be downloaded here: http://summit.sfu.ca/item/17669
... Mobility may not be as influenced by social capital as other local traits. Research on mobility should consider the relationships between the neighbourhood and individual-level factors [40]. This technology Holoportation can make individual interaction without being there which will be a world-class phenomenon for communication technology. ...
... Mobility has been linked to independence (Schwanen et al. 2012) and characteristics of the built environment (Rosso et al. 2011;Hanson et al. 2012;Yen et al. 2014;Cerin et al. 2017). Mobility as a means of social interactions in later life has recently caught the interests of researchers but needs to be further explored (Gardner 2011(Gardner , 2014Hanson et al. 2012;Rosso et al. 2013Rosso et al. , 2014Van Holle et al. 2016;Cerin et al. 2017). Work in geographical gerontology and the "new mobilities paradigm" also point toward conceptualizing the neighbourhood as a relation space, supporting social participation and inclusion in later life (Burnett and Lucas 2010;Ziegler 2012;Peace 2013). ...
The concept of “ageing in place” has become increasingly significant in the environmental gerontology literature. Despite its predominance, there have been limited efforts to offer a more comprehensive and nuanced conceptualization of this topic. Definitions found in the literature are often too simplistic and only partially capture the various aspects of older adults’ experience while ageing in place. This paper presents a conceptual framework on ageing in place in the context of neighbourhood environment which aims to address this gap by proposing a multi-faceted understanding of ageing in place processes through the lenses of a capability approach, a more comprehensive definition of the concept, and related overarching principles. Building on predominant theories in environmental gerontology, this conceptual framework offers new insights into the interactions between “place” and the “ageing individual”. It is meant to offer opportunities for discussion, to suggest new paths of inquiry, and to explore implications for policy and practice.
... In studying collective efficacy as conceptually distinct from social cohesion, researchers with theoretical roots in psychology have utilized Sampson and colleagues' collective efficacy measurement tool by dividing it into the two subscales-social cohesion and social control (Collins et al. 2014;Wickes et al. 2013). The latter has sometimes been relabeled as collective efficacy (e.g., Collins et al. 2014; for a review, see Wickes et al. 2013), with the former referred to as bonding social capital (e.g., Brisson et al. 2009;Brisson and Usher 2007) or neighborhood social capital (Jung and Viswanath 2013;Prins et al. 2014;Rosso et al. 2014). Zaccaro et al. (1995) apply this approach when they state that social cohesion is a consequence of collective efficacy. ...
Collective efficacy is an often‐studied concept, yet theoretical differences and confusing terminology lead to an inability to translate the concept across disciplines. Utilizing a nationally representative sample, this study employs structural equation modeling combined with a series of hierarchical models to test the hypotheses that the focal independent variables of neighborhood perceptions, strong social ties, and civic engagement as a proxy for weak social ties are each positively associated with collective efficacy while controlling for sociodemographic characteristics. Findings show that all the focal independent variables were positively associated with collective efficacy. The full model accounts for nearly half the variance in collective efficacy. These results support other, recent research findings that the collective efficacy measure is more highly associated with respondent perceptions of the community and strong social ties than originally theorized.
... The social cohesion subscale created by Sampson et al. (1997) is conceptually analogous to bonding social capital (Lochner, Kawachi, & Kennedy, 1999). Based on a comprehensive review of the literature, Cancino (2005) notes, it has become more common to disaggregate the two measures of collective efficacy as well as to utilize the social cohesion subscale as a proxy for bonding social capital (e.g., Brisson, Roll, & East, 2009;Brisson & Usher, 2007;Collins, Neal, & Neal, 2014, 2017Jung, Lin, & Viswanath, 2013;Prins et al., 2014;Rosso, Tabb, Grubesic, Taylor, & Michael, 2014). ...
Neighbourhood perceptions have important implications for individual well‐being, yet there is limited research focused on variables that predict these perceptions. This study proposes that previous engagement in collective action mediates the relationship between neighbourhood bonding social capital and neighbourhood perceptions. Structural equation modelling with a large, nationally representative sample (N = 25,370) is used to test the hypotheses. The findings suggest that bonding social capital has a positive, direct effect on both neighbourhood perceptions and collective action. Collective action has a negative, direct association with neighbourhood perceptions and bonding social capital has a negative, indirect effect on neighbourhood perceptions via collective action. Although the full model explains 28% of the variance in neighbourhood perceptions, bonding social capital only explains 5% of the variance in collective action.
... Despite its importance, social capital does not predict all aspects of health and quality of life. For example, social capital is not linked to older adults' mobility once after controlling for other neighborhood characteristics (Rosso, Tabb, Grubesic, Taylor, & Michael, 2014). ...
Objectives: Prior research has shown social capital and built environment quality are associated with overall health status and the incidence of mental illness. This study explores the relationship between social capital, built environment, and quality of life specifically for assisted living residents, currently a gap in the literature. Method: A total of 76 assisted living residents were interviewed for the study using researcher-administered questionnaires. In addition, site audits were conducted to quantitatively evaluate the built environment surrounding 12 assisted living communities in the Louisville Metro region. Results: There was a moderate, positive correlation between social capital and mental health, r = .473, p < .001. Built environment quality for the neighborhood immediately surrounding the assisted living community was not significantly correlated with quality of life for assisted living residents. Other population characteristics, including demographic characteristics, self-rated health status, and instrumental activities of daily living were not significantly predictive of mental health scores. Conclusion: This study demonstrates that social capital is associated with happiness and self-rated quality of life. Specifically, increased social capital is associated with increased mental well-being for older adults residing in assisted living communities, with social capital explaining about 20% of the variation in quality of life scores.
... Higher social classes will tend to cluster together through exchanging and expanding their resources such as access to career, business, and power influences (Kraus, Piff, & Keltner, 2009). Lowincome populations tend to live in high-poverty neighborhoods, which may constrain their resource exchange and social networks (Hofferth & Iceland, 1998;Rosso, Tabb, Grubesic, Taylor, & Michael, 2014). Some evidence also showed that social groups tend to consist of like thinkers (Forgas, 1985), as reflected in the old adage "birds of a feather flock together," and it is highly possible that a low-income family will get less support from their family members and relatives. ...
The impact of economic circumstances on marital quality has been widely studied in Western countries; however, there is still no empirical evidence to examine this association in a Chinese context. This study aimed to investigate the impact of family income on marital happiness and associated psychosocial mechanisms among urban Chinese residents. Based on a national representative sample of 2,132 men and 2,394 women, the results demonstrated that low-income urban couples reported lower marital happiness compared with their higher income counterparts. For married women, low-income status increased the spousal hostility toward them, which in turn made them unhappy with their marriage, but this psychological mechanism did not happen to married men similarly. In addition, low-income status decreased both men’s and women’s perception of social support from family members and thus exerted a negative influence on their marital happiness. It is suggested that social work intervention programs aiming at low-income families should target their economic difficulties, help manage their assets, and deal with psychosocial relationships.
Background
Attention is focused on the health and physical fitness of older adults due to their increasing age. Maintaining physical abilities, including safe walking and movement, significantly contributes to the perception of health in old age. One of the early signs of declining fitness in older adults is limited mobility. Approximately one third of 70-year-olds and most 80-year-olds report restrictions on mobility in their apartments and immediate surroundings. Restriction or loss of mobility is a complex multifactorial process, which makes older adults prone to falls, injuries, and hospitalizations and worsens their quality of life while increasing overall mortality.
Objective
The objective of the study is to identify the factors that have had a significant impact on mobility in recent years and currently, and to identify gaps in our understanding of these factors. The study aims to highlight areas where further research is needed and where new and effective solutions are required.
Methods
The PRISMA methodology was used to conduct a scoping review in the Scopus and Web of Science databases. Papers published from 2007 to 2021 were searched in November 2021. Of these, 52 papers were selected from the initial 788 outputs for the final analysis.
Results
The final selected papers were analyzed, and the key determinants were found to be environmental, physical, cognitive, and psychosocial, which confirms the findings of previous studies. One new determinant is technological. New and effective solutions lie in understanding the interactions between different determinants of mobility, addressing environmental factors, and exploring opportunities in the context of emerging technologies, such as the integration of smart home technologies, design of accessible and age-friendly public spaces, development of policies and regulations, and exploration of innovative financing models to support the integration of assistive technologies into the lives of seniors.
Conclusion
For an effective and comprehensive solution to support senior mobility, the determinants cannot be solved separately. Physical, cognitive, psychosocial, and technological determinants can often be perceived as the cause/motivation for mobility. Further research on these determinants can help to arrive at solutions for environmental determinants, which, in turn, will help improve mobility. Future studies should investigate financial aspects, especially since many technological solutions are expensive and not commonly available, which limits their use.
Objective:
The authors compared the effects of a standard strength and endurance physical therapist intervention to a standard plus timing and coordination training intervention on community mobility measured using global positioning systems (GPS) among community-dwelling older adults in this secondary analysis of a randomized controlled trial.
Methods:
Participants were randomized to a standard or a standard plus timing and coordination training program. Community mobility was measured using the Life Space Assessment and GPS indicators of community mobility at baseline, as well as at 12 (immediately after the intervention), 24, and 36 weeks. Linear mixed models were used for analysis.
Results:
There were 166 participants with GPS data at baseline, including 81 in the standard plus group and 85 in the standard group. The groups did not differ in participant characteristics or GPS measures at baseline. There were no significant within-group changes in GPS indicators of community mobility or Life Space Assessment score over time, nor between-group differences of the same.
Conclusions:
There were no significant changes in community mobility with either intervention or between-intervention differences. These findings suggest that physical therapist interventions targeting physical function alone may not be sufficient to improve community mobility or participation in older adults. Future research should focus on the development of multifaceted interventions targeted to improve real-world participation.
Impact:
The studied interventions did not significantly change community mobility measured using GPS-derived community mobility measures or self-report measures in older adults, suggesting that more comprehensive interventions may be needed to target improvements in community mobility.
Barriers to access impede availing oneself of opportunities to access exercise and achieve health, and a myriad of systemic factors contribute to the barriers that exist. The lack of access and opportunnities for exercise can lead in the development of secondary conditions that further adversely impact the overall health of individuals. In addition to the physical and logistical barriers, those with mobility limitations also face both overt barriers to access such as being made to feel unwelcome due to lack of effort made to make exercise facilities and opportunities accessible and covert barriers based on subpar customer service provided to them due to a lack of understanding of how to assist them much less the legal obligation in terms of doing so. Additional research needs to be conducted to assess the extent to which barriers impeed access and opportunity to exercise: with added data, patterns can be identified that will allow the identified issues to be remedied thereby allowing those with limited mobility to reap the benefits of exercise and avoid the secondary effects of limited mobility. Solutions to these problems involve greater societal, exercise, and health facility planning to address the complete social, personal, and environmental components that impact all aspects of individual health needs.
Background: The built, social and economic environments are associated with disability, but knowledge of how these environmental characteristics simultaneously influence older adults’ ability to shop independently is limited.
Objective: We investigated cross-sectional associations between the outdoor home, local neighborhood and macrosocioeconomic levels of the environment and shopping difficulty and interactions between environmental factors and shopping difficulty.
Methods: Using nationally representative data from a study of Medicare-eligible adults, we conducted a cross-sectional secondary data analysis to examine associations between the environment and difficulty shopping (N = 5504).
Results: Sidewalk conditions, broken steps, neighborhood social cohesion and neighborhood socioeconomic disadvantage were associated with more difficulty shopping, although health factors partially accounted for associations between broken steps and disadvantage and shopping difficulty. The association between social cohesion and shopping difficulty also depended on the degree of socioeconomic disadvantage in the neighborhood.
Conclusions: Overall, results suggest that factors in the outdoor and local neighborhood environment influence the ability to shop independently for older adults, but that it also may depend on the socioeconomic context of the neighborhood. Interventions aimed at improving the built environment directly outside of older adults’ homes and helping increase social cohesion among neighbors, has the potential to reduce difficulty in carrying out this important activity.
• Implications for rehabilitation
• Built features of the outdoor home environment including sidewalks and broken steps influence whether older adults are able to safely leave their home to conduct daily activities such as shopping, so it is important that clinicians and rehabilitation professionals are aware of these challenges when helping their patients resume daily activities such as shopping.
• The physical condition and safety of the immediate outdoor home and neighborhood environment is critical for maintaining independence and well-being for older adults, which is critical for physical rehabilitation as well as maintenance of essential activities such as shopping.
• Living in more socially cohesive neighborhoods may aid in physical rehabilitation efforts by helping older adults feel more comfortable and able to shop independently in neighborhoods with social and economic disadvantages.
Social capital can be defined broadly as the resources available to individuals and groups through their social connections to their communities (1). Although the precise definition of social capital is contested and continues to evolve, most definitions emphasize its characteristic as a collective good (1). Social capital can be considered a kind of public good that is provided by a group or community, and, consequently, the benefits of social capital tend to be more widely shared by members of the community. It is the collective dimension of social capital that most sharply distinguished it from other existing concepts, such as social networks and social support. A classic example of this distinction, which we develop further in the following case study, is the individual who may lack social ties and social support on a personal level but nevertheless benefits from residing within a community that is rich in social connections. In turn, communities with high stocks of social capital may be more effective in responding to external health threats, such as natural disasters, or the threatened closure of local health services. Such communities are also better equipped to protect the health of its citizens, even those who are socially isolated. The social connections that exist within a community therefore represent a form of capital that can be leveraged for health gain (1).
Is neighborhood disadvantage associated with social support? If so, does residential stability modify that association? And are there gender- and race-contingent patterns? Among a sample of adults aged 65 years and older, neighborhood disadvantage is associated positively with received and donated support among black women, but only in neighborhoods with higher levels of residential stability. In contrast, neighborhood disadvantage is associated negatively with donated support among white men and negatively with received support among white women, but only under conditions of low residential stability. I discuss the implications of these findings for theories about stress and community-level effects on social relationships in late life and draw linkages to the broader sociological discourse on social capital and collective efficacy.
The low mobility of seniors may be due in part to a history of auto-oriented transportation and land use policy decisions. More recently, land use policies that make it possible to drive less show promise of effectiveness for the population as a whole. However, little attention has been paid to the implications of such policies for older people. Using data collected from Northern California in 2003, this study explores the ability of neighborhood design to preserve accessibility for the elderly by enabling a shift from driving to transit and walking, controlling for confounding factors. The results show that overall, older people drive less and use alternative modes more often than younger people. After controlling for attitudes and socio-demographics, neighborhood design has limited effects on driving and transit use, but enhancing accessibility tends to be a promising strategy for promoting walking trips. This enhanced accessibility has a much larger effect on the elderly than on the younger. Therefore, neighborhood design seems to be an important aspect of sustaining the accessibility of older people.
Neighborhood influences on children and youth are the subjects of increasing numbers of studies, but there is concern that these investigations may be biased, because they typically rely on census-based units as proxies for neighborhoods. This pilot study tested several methods of defining neighborhood units based on maps drawn by residents, and compared the results with census definitions of neighborhoods. When residents' maps were used to create neighborhood boundary definitions, the resulting units covered different space and produced different social indicator values than did census-defined units. Residents' agreement about their neighborhoods' boundaries differed among the neighborhoods studied. This pilot study suggests that discrepancies between researcher and resident-defined neighborhoods are a possible source of bias in studies of neighborhood effects.
Although various studies have found a positive association between neighborhood social capital and individual health, the mechanism explaining this direct effect is still unclear. Neighborhood social capital is the access to resources that are generated by relationships between people in a friendly, well-connected and tightly knit neighborhood community. We expect that the resources generated by cohesive neighborhoods support and influence health -improving behaviors in daily life. We identify five different health-related behaviors that are likely to be affected by neighborhood social capital and test these behaviors separately as mediators.
The data set pertaining to individual health was taken from the 'health interview' in the 'Second Dutch national survey of general practice' (DNSGP-2, 2002). We combine these individual-level data with data from the 'Dutch housing demand survey' (WBO, 1998 and WoON, 2002) and statistical register information (1995-1999). Per neighborhood 29 WBO respondents, on average, had answered questions regarding social capital in their neighborhood. These variables have been aggregated to the neighborhood level by an ecometric methodology. In the main analysis, in which we tested the mediation, multilevel (ordered) logistic regressions were used to analyze 9253 adults (from the DNSGP-2 data set) from 672 Dutch neighborhoods. In the Netherlands, on average, neighborhoods (4-digit postcodes) comprise 4,000 inhabitants at highly variable population densities. Individual- and neighborhood-level controls have been taken into account in the analyses.
In neighborhoods with a high level of social capital, people are more physically active and more likely to be non-smokers. These behaviors have positive effects on their health. The direct effect of neighborhood social capital on health is significantly and strongly reduced by physical activity. This study does not support nutrition and sleep habits or moderate alcohol intake as possible explanations of the effects of neighborhoods on health.
This study is one of the first to test a mechanism explaining much of the direct effect of small-area social capital on individual health. Neighborhood interventions might be most successful at improving health if they stimulate both social interaction and physical activity.
Objectives. Community processes are key determinants of older adults' ability to age in place, but existing scales measuring these constructs may not provide accurate, unbiased measurements among older adults because they were designed with the concerns of child-rearing respondents in mind. This study examines the properties of a new theory-based measure of collective efficacy (CE) that accounts for the perspectives of older residents. Methods. Data come from the population-based Chicago Neighborhood Organization, Aging and Health study (N = 1,151), which surveyed adults aged 65 to 95. Using descriptive statistics, correlations, and factor analysis, we explored the acceptability, reliability, and validity of the new measure. Results. Principal component analysis indicated that the new scale measures a single latent factor. It had good internal consistency reliability, was highly correlated with the original scale, and was similarly associated with neighborhood exchange and disorder, self-rated health, mobility, and loneliness. The new scale also showed less age-differentiated nonresponse compared to the original scale. Discussion. The older adult CE scale has reliability and validity equivalent to that of the existing measure but benefits from a more developed theoretical grounding and reduced likelihood of age-related differential nonresponse.
Mobility restrictions in older adults are common and increase the likelihood of negative health outcomes and premature mortality. The effect of built environment on mobility in older populations, among whom environmental effects may be strongest, is the focus of a growing body of the literature. We reviewed recent research (1990-2010) that examined associations of objective measures of the built environment with mobility and disability in adults aged 60 years or older. Seventeen empirical articles were identified. The existing literature suggests that mobility is associated with higher street connectivity leading to shorter pedestrian distances, street and traffic conditions such as safety measures, and proximity to destinations such as retail establishments, parks, and green spaces. Existing research is limited by differences in exposure and outcome assessments and use of cross-sectional study designs. This research could lead to policy interventions that allow older adults to live more healthy and active lives in their communities.
This study examined what variables best predict concerns about neighborhood safety among middle-aged and older adults. Eighty-five participants were selected from a Midwestern urban area. Participants completed a 22-item questionnaire that assessed their perceptions of neighborhood safety and vigilance. These items were clustered as: (a) community care and vigilance, (b) safety concerns, (c) physical incivilities, and (d) social incivilities. Police crime data were also used in the analyses. Our findings suggest that aspects of the broken window theory, collective efficacy, and place attachments play a role in affecting residents' perceptions of neighborhood safety.
We investigated whether lack of perceived neighborhood safety due to crime, or living in high crime neighborhoods was associated with incident mobility disability in elderly populations. We hypothesized that low-income elders and elders at retirement age (65 - 74) would be at greatest risk of mobility disability onset in the face of perceived or measured crime-related safety hazards.
We conducted the study in the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE), a longitudinal cohort study of community-dwelling elders aged 65 and older who were residents of New Haven, Connecticut in 1982. Elders were interviewed beginning in 1982 to assess mobility (ability to climb stairs and walk a half mile), perceptions of their neighborhood safety due to crime, annual household income, lifestyle characteristics (smoking, alcohol use, physical activity), and the presence of chronic co-morbid conditions. Additionally, we collected baseline data on neighborhood crime events from the New Haven Register newspaper in 1982 to measure local area crime rates at the census tract level.
At baseline in 1982, 1,884 elders were without mobility disability. After 8 years of follow-up, perceiving safety hazards was associated with increased risk of mobility disability among elders at retirement age whose incomes were below the federal poverty line (HR 1.56, 95% CI 1.02 - 2.37). No effect of perceived safety hazards was found among elders at retirement age whose incomes were above the poverty line. No effect of living in neighborhoods with high crime rates (measured by newspaper reports) was found in any sub-group.
Perceiving a safety hazard due to neighborhood crime was associated with increased risk of incident mobility disability among impoverished elders near retirement age. Consistent with prior literature, retirement age appears to be a vulnerable period with respect to the effect of neighborhood conditions on elder health. Community violence prevention activities should address perceived safety among vulnerable populations, such as low-income elders at retirement age, to reduce future risks of mobility disability.
To characterize the influence of the residential neighborhood of older adults on the prevalence of disability.
We combined Census data on disability in older adults living in New York City with environmental information from a comprehensive geospatial database. We used factor analysis to derive dimensions of compositional and physical neighborhood characteristics and linear regression to model their association with levels of disability. Measures of neighborhood collective efficacy were added to these models to explore the impact of the social environment.
Low neighborhood socioeconomic status, residential instability, living in areas with low proportions of foreign born and high proportions of Black residents, and negative street characteristics were associated with higher prevalence of both "physical" disability and "going outside the home" disability. High crime levels were additionally associated with physical disability, although this relationship disappeared when misdemeanor arrests were removed from the crime variable. Low levels of collective efficacy were associated with more going-outside-the-home disability, with racial/ethnic composition dropping out of this model to be replaced by an interaction term.
The urban environment may have a substantial impact on whether an older adult with a given level of functional impairment is able to age actively and remain independent.
Objectives. To examine the role of neighborhood social conditions and walking in community-dwelling older adults. Methods. A multi-level analysis of data from 4,317 older adults (mean age = 74.5; 73% black) from a geographically-defined urban community. Participants completed structured interviews including 14 questions on neighborhood conditions and self-reported walking. The neighborhood questions were summarized into individual-level measures of perceived neighborhood social cohesion and disorder. These measures were aggregated by neighborhood to construct neighborhood-level measures of social cohesion and disorder. Results. Neighborhood-level disorder, but not social cohesion, was significantly associated with walking, independent individual-level neighborhood perceptions and other correlates of walking. Further adjustment for race weakened this association to a marginally significant level. Discussion. Neighborhood conditions may shape walking behavior in older adults, especially conditions that reflect physical neglect or social threat. Promotion of walking behavior in older adults may require improvement of the safety and upkeep of the neighborhood environment.
A short battery of physical performance tests was used to assess lower extremity function in more than 5,000 persons age 71 years and older in three communities.
Balance, gait, strength, and endurance were evaluated by examining ability to stand with the feet together in the side-by-side, semi-tandem, and tandem positions, time to walk 8 feet, and time to rise from a chair and return to the seated position 5 times.
A wide distribution of performance was observed for each test. Each test and a summary performance scale, created by summing categorical rankings of performance on each test, were strongly associated with self-report of disability. Both self-report items and performance tests were independent predictors of short-term mortality and nursing home admission in multivariate analyses. However, evidence is presented that the performance tests provide information not available from self-report items. Of particular importance is the finding that in those at the high end of the functional spectrum, who reported almost no disability, the performance test scores distinguished a gradient of risk for mortality and nursing home admission. Additionally, within subgroups with identical self-report profiles, there were systematic differences in physical performance related to age and sex.
This study provides evidence that performance measures can validly characterize older persons across a broad spectrum of lower extremity function. Performance and self-report measures may complement each other in providing useful information about functional status.
The purpose of this study was to devise and test a conceptual model that explains how neighborhood quality, fear of crime, and received emotional support affect an elderly person's expectations of future assistance should the need arise (i.e., anticipated support).
Using a nationwide survey of older adults, a series of nested latent variable models was tested to determine if the social support process differs between older adults living alone and those living with others.
Consistent with a social ecological perspective, data suggest that anticipated support is lower among elders who live in deteriorated neighborhoods than among older adults who live in well-maintained neighborhoods. Moreover, the deleterious effects of run-down neighborhoods appear to be especially pronounced for older adults who live alone.
Select constructs that link deteriorated neighborhoods with anticipated support are explored. Suggestions for future research are made.
To examine any association between social, productive, and physical activity and 13 year survival in older people.
Prospective cohort study with annual mortality follow up. Activity and other measures were assessed by structured interviews at baseline in the participants' homes. Proportional hazards models were used to model survival from time of initial interview.
City of New Haven, Connecticut, United States.
2761 men and women from a random population sample of 2812 people aged 65 and older.
Mortality from all causes during 13 years of follow up.
All three types of activity were independently associated with survival after age, sex, race/ethnicity, marital status, income, body mass index, smoking, functional disability, and history of cancer, diabetes, stroke, and myocardial infarction were controlled for.
Social and productive activities that involve little or no enhancement of fitness lower the risk of all cause mortality as much as fitness activities do. This suggests that in addition to increased cardiopulmonary fitness, activity may confer survival benefits through psychosocial pathways. Social and productive activities that require less physical exertion may complement exercise programmes and may constitute alternative interventions for frail elderly people.
We examined the association of structural and functional aspects of social relationships with change in disability, and the degree to which race modifies these associations.
Data are from a population-based sample of 4,136 African Americans and Whites aged > or = 65 living in North CAROLINA: Disability data were collected during seven consecutive yearly interviews and summarized in two outcome measures. Measures of social relationships included five measures representing network size, extent of social interaction, and specific type of relationships, as well as instrumental and emotional support. Weighted proportional odds models were fitted to model disability as a function of baseline social network and support variables, and the interaction of each variable with follow-up time.
Network size and social interaction showed significant negative associations with disability risks, which did not vary by race, or as a function of time. Social interaction with friends was associated with a reduced risk for disability, but social interaction with children or relatives was not related to disability. Instrumental support was associated with a significantly increased disability risk, with a greater adverse effect among Whites than African AMERICANS: Emotional support was not associated with disability, but a protective effect for ADL disability was found after controlling for its intercorrelation with instrumental support.
The findings provide further evidence for the role of social relationships in the disablement process, although not all types of social relationships may be equally beneficial. Furthermore, these associations may be more complex than simple causal effects. There were few racial differences in the association of social relationships with disability, with the possible exception of instrumental support, which may allude to possible sociocultural differences in the experience of instrumental support exchanges.
In this paper we highlight what we consider to be a lack of adequate conceptualisation. operationalisation and measurement of "place effects". We briefly review recent historical trends in the study of the effects of place on health in industrial countries, and argue that "place effects" often appear to have the status of a residual category, an unspecified black box of somewhat mystical influences on health which remain after investigators have controlled for a range of individual and place characteristics. We note that the distinction between "composition" and "context" may be more apparent than real, and that features of both material infrastructure and collective social functioning may influence health. We suggest using a framework of universal human needs as a basis for thinking about how places may influence health, and recommend the testing of hypotheses about specific chains of causation that might link place of residence with health outcomes.
Several empirical studies have suggested that neighborhood characteristics influence health, with most studies having focused on neighborhood deprivation or aspects of the physical environment, such as services and amenities. However, such physical characteristics are not the only features of neighborhoods that potentially affect health. Neighborhoods also matter because of the nature of their social organization. This study examined social capital as a potential neighborhood characteristic influencing health. Using a cross-sectional study design which linked counts of death for persons 45-64 years by race and sex to neighborhood indicators of social capital and poverty for 342 Chicago neighborhoods in the USA, we tested the ecological association between neighborhood-level social capital and mortality rates, taking advantage of the community survey data collected as part of the Project on Human Development in Chicago Neighborhoods. We estimated a hierarchical generalized linear model to examine the association of race and sex specific mortality rates to social capital. Overall, neighborhood social capital-as measured by reciprocity, trust, and civic participation-was associated with lower neighborhood death rates, after adjustment for neighborhood material deprivation. Specifically, higher levels of neighborhood social capital were associated with lower neighborhood death rates for total mortality as well as death from heart disease and "other" causes for White men and women and, to a less consistent extent, for Blacks. However, there was no association between social capital and cancer mortality. Although, the findings from this study extend the state-level findings linking social capital to health to the level of neighborhoods, much work remains to be carried out before social capital can be widely applied to improve population health, including establishing standards of measurement, and exploring the potential "downsides" of social capital.
This paper examines the effect of social engagement on disability among community-dwelling older adults in 1982-1991. Data were collected from the New Haven, Connecticut, site of the Established Populations for Epidemiologic Studies of the Elderly. Baseline social engagement was measured by using 11 items related to social and productive activity. Disability data consisted of a six-item measure of activities of daily living, a three-item measure of gross mobility, and a four-item measure of basic physical functions. Nine waves of yearly disability data were analyzed by using generalized estimating equations models. After adjustment for age, gender, race, and physical activity, significant cross-sectional associations (p's < 0.001) were found between social engagement and all three measures of disability, with more socially engaged older adults reporting less disability. Social engagement also showed small, but negative interaction effects with follow-up-time outcomes (p's < 0.01), indicating that the protective effect of social engagement decreased slightly during follow-up. Results suggest a strong, but not necessarily causal association of social engagement with disability. Promotion of social engagement may still be important for the prevention of disability.
The Disablement Process model explicates the transition from health conditions to disability and specifically emphasizes the role of intervening factors that speed up or slow down the pathway between pathology and disability.
We used hierarchical Poisson regression analyses with data on older adults from central North Carolina to examine the role of the built environment as a modifying factor in the pathway between lower extremity functional limitations and activities of daily living. We found that, despite declining physical function, older adults report greater independence in instrumental activities when they live in environments with more land-use diversity.
Independence in self-care activities is modified by housing density, in part through the effect of substandard and inadequate housing.
The authors of this excellent text define social epidemiology as the epidemiologic study of the social distribution and social determinants of states of health, implying that the aim is to identify socio-environmental exposures which may be related to a broad range of physical and mental health outcomes. In the first systematic account of this field, they focus on methodological approaches but draw widely from related disciplines such as sociology, psychology, physiology, and medicine in the effort to develop and evaluate testable hypotheses about the pathways between social conditions and health. The persistent patterns of social inequalities in health make this a timely publication.
Do places make a difference to people's health and well-being? This book demonstrates how the physical and social characteristics of a neighborhood can shape the health of its residents. Researchers have long suspected that where one lives makes a difference to health in addition to who one is. Almost everyone understands that smoking, unhealthy eating, lack of exercise can compromise longevity and good health, but can a person's ability to maintain a healthy lifestyle be affected by the smoking habits of other people close by, or access to grocery stores, or the existence of safe parks and recreational space? The answers to this question and other similar ones require new ways of thinking about the determinants of health as well as new analytical methods to test these ideas. This book brings together these ideas and new methods. The book contains various parts. The first part deals with methodological complexities of undertaking neighborhood research. The second part showcases the empirical evidence linking neighborhood conditions to health outcomes. The last part tackles some of the major cross-cutting themes in contemporary neighborhood research.
Social capital is the web of cooperative relationships between citizens that facilitates resolution of collection action problems (Coleman 1990; Putnam 1993). Although normally conceived as a property of communities, the reciprocal relationship between community involvement and trust in others is a demonstration of social capital in individual behavior and attitudes. Variation in social capital can be explained by citizens' psychological involvement with their communities, cognitive abilities, economic resources, and general life satisfaction. This variation affects citizens' confidence in national institutions, beyond specific controls for measures of actual performance. We analyze the pooled General Social Surveys from 1972 to 1994 in a latent variables framework incorporating aggregate contextual data. Civic engagement and interpersonal trust are in a tight reciprocal relationship, where the connection is stronger from participation to interpersonal trust, rather than the reverse.
To examine the association between social capital and adherence to cancer screening exams.
Data from a population-based survey assessed perceived neighborhood social capital as well as cancer screening behavior. We analyzed the influence of social capital on adherence to screening guidelines for cervical, breast, and colorectal cancer.
Data from 2668 adults documented that those with greater perceived neighborhood social capital were more likely to be screened for cancer. The effect was strongest for colorectal cancer and weakest for cervical cancer.
Research on understanding the effect of the neighborhood social environment on efforts related to cancer screening behavior may be helpful for increasing cancer screening rates.
Objective:
To examine cross sectional associations between mobility with or without disability and social engagement in a community-based sample of older adults.
Methods:
Social engagement of participants (n = 676) was outside the home (participation in organizations and use of senior centers) and in home (talking by phone and use of Internet). Logistic or proportional odds models evaluated the association between social engagement and position in the disablement process (no mobility limitations, mobility limitations/no disability, and mobility limitations/disability).
Results:
Low mobility was associated with lower level of social engagement of all forms (Odds ratio (OR) = 0.59, confidence intervals (CI): 0.41-0.85 for organizations; OR = 0.67, CI: 0.42-1.06 for senior center; OR = 0.47, CI: 0.32-0.70 for phone; OR = 0.38, CI: 0.23-0.65 for Internet). For social engagement outside the home, odds of engagement were further reduced for individuals with disability.
Discussion:
Low mobility is associated with low social engagement even in the absence of disability; associations with disability differed by type of social engagement.
Social capital has previously been reviewed in relation to mental health. However, none have focused specifically on positive aspects of mental health such as mental well-being. This review aimed to explore the relationship between social capital and mental well-being in older people. Ten relevant databases were systematically searched using an extensive search strategy for studies, analyzing the link between social capital and mental well-being. Criteria for inclusion in the systematic review were: the study sample included older people (≥50 years); the study reported a mental well-being outcome; social capital was an exposure variable; and empirical research using quantitative methods and published in English, between January 1990 and September 2011. Eleven studies met the inclusion criteria. Each study was assessed against seven possible exposure measures (structural, cognitive; bonding, bridging, linking; individual, collective). The results showed that all included studies found positive associations between parts of social capital and aspects of mental well-being. Typically, the relationship between social capital and mental well-being differed within as well as between studies. Our results highlight that there is no 'gold standard' of how to measure social capital or mental well-being. Social capital is generated in the interaction between individual and collective life. A possibility for future research is therefore to follow Bronfenbrenner's classical division into macro, meso, and micro levels. We consider family and friends at the micro level to be the key factors in generating social capital and well-being in older people.
The current study draws on data from the 2007 and 2009 Citizenship Survey collected in England (n=17,572) to explore the role of social capital in building community resilience and health, using the bonding, bridging, and linking social capital framework of Szreter and Woolcock (2004). The results show that the indicators of the different types of social capital are only weakly interrelated, suggesting that they capture different aspects of the social environment. In line with the expectations, most indicators of bonding, bridging, and linking social capital were significantly associated with neighbourhood deprivation and self-reported health. In particular bonding and bridging social cohesion, civic participation, heterogeneous socio-economic relationships, and political efficacy and trust appeared important for community health after controlling for neighbourhood deprivation. However, no support was found for the hypothesis that the different aspects help buffer against the detrimental influences of neighbourhood deprivation.
Why are some communities more cohesive than others? The answer to the puzzle has two parts: (a) due to variations in the attributes of residents, and/or (b) due to variations in the attributes of places. However, few studies have sought to examine the community-level determinants of social capital. In the present study, we examined the associations between social capital and different area characteristics: (1) neighborhood walkability, (2) date of community settlement, and (3) degree of urbanization. We based our analysis on 9414 respondents from the Aichi Gerontological Evaluation Study (AGES), conducted in 2003. No significant positive association was found between the walkability score and any of the social capital indices. In contrast, community age and degree of urbanization were associated with many of the social capital indicators, even after controlling for characteristics of the residents. Community social capital thus appears to be more consistently linked to the broader historical and geographic contexts of neighborhoods, rather than to the proximal built environment (as measured by walkability).
This study examined the associations between social networks, social support, social cohesion, and perceived neighborhood safety among an ethnically diverse sample of 1352 residents living in 12 low-income public housing sites in Boston, Massachusetts. For males and females, social cohesion was associated with perceived safety. For males, a smaller social network was associated with greater feelings of safety. Social support was not a significant predictor of perceived safety. The findings reported here are useful in exploring a potential pathway through which social environmental factors influence health and in untangling the complex set of variables that may influence perceived safety.
Using a multilevel study design, this study examined the associations between social characteristics of individuals and neighbourhoods and physical activity among women. Women (n = 1405) recruited from 45 Melbourne (Australia) neighbourhoods of varying socioeconomic disadvantage provided data on social factors and leisure-time: physical activity; walking; and walking in one's own neighbourhood. Individual level social factors were number of neighbours known and social participation. Neighbourhood-level social characteristics (interpersonal trust, norms of reciprocity, social cohesion) were derived by aggregating survey data on these constructs within neighbourhoods. Objective data on crimes within neighbourhoods were obtained from Victoria Police. In bivariable regression models, all social variables at both the individual and neighbourhood level were positively associated with odds of physical activity, walking, and walking in one's own neighbourhood. Associations with individual social participation (associated with all three physical activity variables) and neighbourhood interpersonal trust (associated with overall physical activity only) remained significant in multivariable models. Neither neighbourhood crime against the person nor incivilities were associated with any form of physical activity. These results demonstrate that women who participated in local groups or events and, less consistently, women living in neighbourhoods where residents trusted one another, were more likely to participate in leisure-time physical activity. While redressing macro-level social and economic policies that contribute to neighbourhood inequalities remains a priority, public health initiatives aimed at promoting physical activity could consider focusing on fostering social interactions targeting both individuals and communities. Further investigation of causal mechanisms underlying these associations is required.
This paper reviews the contribution that the concept of social capital might make to geography, and the contribution geography might make to the analysis of social capital. We begin by summarizing the conceptual origins and dimensions of social capital, in the process of which we distinguish it from several other social properties (human and cultural capital; social networks). We then summarize key criticisms of the concept, especially those levelled at the work of Robert Putnam. The core of the paper is a discussion of the issue of whether there might be a geography of social capital. We consider links between geographical debates and the concept of social capital, and we assess the difficulties of deriving spatially disaggregated measures of social capital. We illustrate this discussion with reference to literature on three sets of issues: the question of ‘institutional tissue’ and its effects on regional development; the understanding of health inequalities; and the analysis of comparative government performance. In conclusion, we argue that the popularity of the concept reflects a combination of academic and political developments, notably the search for ostensibly ‘costless’ policies of redistribution on the part of centrist governments. We therefore conclude with a discussion of the practical applications of the concept in different contexts.
Mobility is fundamental to active aging and is intimately linked to health status and quality of life. Although there is widespread acceptance regarding the importance of mobility in older adults, there have been few attempts to comprehensively portray mobility, and research has to a large extent been discipline specific. In this article, a new theoretical framework for mobility is presented with the goals of raising awareness of the complexity of factors that influence mobility and stimulating new integrative and interdisciplinary research ideas. Mobility is broadly defined as the ability to move oneself (e.g., by walking, by using assistive devices, or by using transportation) within community environments that expand from one's home, to the neighborhood, and to regions beyond. The concept of mobility is portrayed through 5 fundamental categories of determinants (cognitive, psychosocial, physical, environmental, and financial), with gender, culture, and biography (personal life history) conceptualized as critical cross-cutting influences. Each category of determinants consists of an increasing number of factors, demonstrating greater complexity, as the mobility environment expands farther from the home. The framework illustrates how mobility impairments can lead to limitations in accessing different life-spaces and stresses the associations among determinants that influence mobility. By bridging disciplines and representing mobility in an inclusive manner, the model suggests that research needs to be more interdisciplinary and current mobility findings should be interpreted more comprehensively, and new more complex strategies should be developed to address mobility concerns.
Population health outcomes are shaped by complex interactions between individuals and the environments in which they live, work and play. Environments encompass streets and buildings (physical environment), attitudes, supports and relationships with others (social environment), as well as social and political systems and policies. The impact of environments on the physical, mental health and functioning of individuals has emerged as a growing body of research in population health and health disparities. Yet, the majority of studies in this area do not focus on older adults even though older adults are particularly susceptible to the characteristics of their local environments. In this paper we review the current state of the health literature on physical environments for healthy ageing, using the International Classification of Functioning Disability and Health as a framework. Collectively, the literature emphasizes the role of supportive, barrier-free environments particularly for older adults who are at greater risk for disability and poor health. As part of our review we identify conceptual as well as methodological limitations in the current literature, including (i) a theoretical and empirical neglect of the underlying mechanisms behind the person-environment relationship; (ii) a lack of studies using nationally representative samples; (iii) over-reliance on cross-sectional data; and (iv) a need for better definition and measurement of person-centered environments. We conclude by offering some suggestions and directions for future research in this area.
As people age, they become more dependent on their local communities, especially when they are no longer able to drive. Uneven or discontinuous sidewalks, heavy traffic, and inaccessible public transportation, are just some of the built environment characteristics that can create barriers for outdoor mobility in later adulthood. A small body of literature has been investigating the role of the built environment on disability, but has been limited to cross-sectional analyses. The purpose of this paper is to further advance this area of research by examining the role of the built environment on long-term trajectories of mobility disability in a national sample of American adults (age 45+) followed over a 15-year period. Using multilevel logistic growth curve models with nationally representative data from the Americans' Changing Lives Study (1986-2001), we find that trajectories of mobility disability are steeper in older age groups. Women and those with lower education had a higher odds of mobility disability over time. The presence of just one chronic health condition doubled the odds of mobility disability at each of the four study waves. Among older adults (age 75+), living in neighborhoods characterized by more motorized travel was associated with an odds ratio for mobility disability that was 1.5 times higher in any given year than for older adults living in environments that were more pedestrian friendly. These results suggest that the built environment can exacerbate mobility difficulties for older adults. When considering ways to minimize disability as the population ages, simple changes in the built environment may be easier to implement than efforts to change risk factors at the individual level.
Neighborhood characteristics such as racial composition and social capital have been widely linked to health outcomes, but the direction of the relationship between these characteristics and health of minority populations is controversial. Given this uncertainty, we examined the relationship between neighborhood racial composition, social capital, and black all-cause mortality between 1997 and 2000 in 68 Philadelphia neighborhoods. Data from the U.S. Census, the Philadelphia Health Management Corporation's 2004 Southeast Pennsylvania Community Health Survey, and city vital statistics were linked by census tract and then aggregated into neighborhoods, which served as the unit of analysis. Neighborhood social capital was measured by a summative score of respondent assessments of: the livability of their community, the likelihood of neighbors helping one another, their sense of belonging, and the trustworthiness of their neighbors. After adjustment for the sociodemographic characteristics of neighborhood residents, black age-adjusted all-cause mortality was significantly higher in neighborhoods that had lower proportion of black residents. Neighborhood social capital was also associated with lower black mortality, with the strongest relationship seen for neighborhoods in the top half of social capital scores. There was a significant interaction between racial composition and social capital, so that the effect of social capital on mortality was greatest in neighborhoods with a higher proportion of black residents and the effect of racial composition was greatest in neighborhoods with high social capital. These results demonstrate that age-adjusted all-cause black mortality is lowest in mostly black neighborhoods with high levels of social capital in Philadelphia.
Longitudinal data sets are comprised of repeated observations of an outcome and a set of covariates for each of many subjects. One objective of statistical analysis is to describe the marginal expectation of the outcome variable as a function of the covariates while accounting for the correlation among the repeated observations for a given subject. This paper proposes a unifying approach to such analysis for a variety of discrete and continuous outcomes. A class of generalized estimating equations (GEEs) for the regression parameters is proposed. The equations are extensions of those used in quasi-likelihood (Wedderburn, 1974, Biometrika 61, 439-447) methods. The GEEs have solutions which are consistent and asymptotically Gaussian even when the time dependence is misspecified as we often expect. A consistent variance estimate is presented. We illustrate the use of the GEE approach with longitudinal data from a study of the effect of mothers' stress on children's morbidity.
To lay the groundwork for devising, improving and implementing strategies to prevent or delay the onset of disability in the elderly, we conducted a systematic literature review of longitudinal studies published between 1985 and 1997 that reported statistical associations between individual base-line risk factors and subsequent functional status in community-living older persons. Functional status decline was defined as disability or physical function limitation. We used MEDLINE, PSYCINFO, SOCA, EMBASE, bibliographies and expert consultation to select the articles, 78 of which met the selection criteria. Risk factors were categorized into 14 domains and coded by two independent abstractors. Based on the methodological quality of the statistical analyses between risk factors and functional outcomes (e.g. control for base-line functional status, control for confounding, attrition rate), the strength of evidence was derived for each risk factor. The association of functional decline with medical findings was also analyzed. The highest strength of evidence for an increased risk in functional status decline was found for (alphabetical order) cognitive impairment, depression, disease burden (comorbidity), increased and decreased body mass index, lower extremity functional limitation, low frequency of social contacts, low level of physical activity, no alcohol use compared to moderate use, poor self-perceived health, smoking and vision impairment. The review revealed that some risk factors (e.g. nutrition, physical environment) have been neglected in past research. This review will help investigators set priorities for future research of the Disablement Process, plan health and social services for elderly persons and develop more cost-effective programs for preventing disability among them.
The environment can be thought of in terms of physical and social dimensions. The social environment includes the groups to which we belong, the neighborhoods in which we live, the organization of our workplaces, and the policies we create to order our lives. There have been recent reports in the literature that the social environment is associated with disease and mortality risks, independent of individual risk factors. These findings suggest that the social environment influences disease pathways. Yet much remains to be learned about the social environment, including how to understand, define, and measure it. The research that needs to be done could benefit from a long tradition in sociology and sociological research that has examined the urban environment, social areas, social disorganization, and social control. We summarize this sociological literature and discuss its relevance to epidemiologic research.
The primary aims of this paper are to review the concept of social capital and related constructs and to provide a brief guide to their operationalization and measurement. We focus on four existing constructs: collective efficacy, psychological sense of community, neighborhood cohesion and community competence. Each of these constructs taps into slightly different, yet overlapping, aspects of social capital. The existence of several instruments to measure each of these constructs calls for further study into their use as measures of social capital. Despite differences in the approach to measurement, there is general agreement that community characteristics, such as social capital, should be distinguished from individual characteristics and measured at the community level.
The past few years have witnessed an explosion of interest in neighborhood or area effects on health. Several types of empiric studies have been used to examine possible area or neighborhood effects, including ecologic studies relating area characteristics to morbidity and mortality rates, contextual and multilevel analyses relating area socioeconomic context to health outcomes, and studies comparing small numbers of well-defined neighborhoods.
Strengthening inferences regarding the presence and magnitude of neighborhood effects will require addressing a series of conceptual and methodological issues. Many of these issues relate to the need to develop theory and specific hypotheses on the processes through which neighborhood and individual factors may jointly influence specific health outcomes. Important challenges include defining neighborhoods or relevant geographic areas, identifying significant area or neighborhood characteristics, specifying the role of individual-level variables, incorporating life-course and longitudinal dimensions, combining a variety of research designs, and avoiding reductionism in the way in which “neighborhood” factors are incorporated into models of disease causation and quantitative analyses.analyses.
Social capital is defined as the resources available to individuals and groups through social connections and social relations with others. Access to social capital enables older citizens to maintain productive, independent, and fulfilling lives. As the U.S. population ages, accompanied by a rise in the prevalence of seniors living alone, the availability of social capital within communities will become an important ingredient of successful aging. Recent evidence suggests that many traditional forms of social capital in communities-as represented by civic engagement in local associations and by the extent of voluntarism and social trust-are on the decline. If this observation in correct, there is no simple solution to rebuilding this lost social capital. Novel forms of senior housing, such as planned care developments and assisted-living facilities, may offer promising modes of delivery of social capital to the aging population. However, assisted living remains financially inaccessible for a large segment of the U.S. population, so investment in communities "aging in place" may be the key to delivering the health dividends of social capital.
Epidemiological research suggests that reduced physical activity and mobility may be associated with depressive symptoms. The present study examines the relative roles of mobility status and physical activity as predictors of depressive symptoms among community-dwelling older adults.
The subjects comprised randomly selected, non-institutionalized residents of the city of Jyväskylä, central Finland, born in 1904-1923. At baseline, 80% (N = 1224) and after the 8-year follow-up period (1996) 88% (N = 663) of eligible persons were interviewed. All non-institutionalized men and women (N = 384) who participated in both baseline and follow-up interviews, who supplied data on the main questions of interest and who had no depressive symptoms at baseline, were selected for analysis. Depressive symptoms were assessed using the Finnish modified version of Beck's 13-item depression scale (RBDI). Physical activity was assessed on a seven-point scale. Mobility status was defined as the ability to walk two kilometers and climb one flight of stairs.
Subjects who were mobility-disabled and had a sedentary life-style had a higher risk (OR = 2.44) for depressive symptoms at follow-up than those who had good mobility and were physically active. The risk was also higher (OR = 1.99) in those who were mobility-disabled and had a physically active life-style, compared with physically active individuals with intact mobility. Those with good mobility had fewer depressive symptoms than those who had mobility problems, irrespective of the level of physical activity. No significant interaction was observed between physical activity and mobility in predicting the development of depressive symptoms. Older age significantly increased, and the number of chronic illnesses tended to increase the risk of developing depressive symptoms during the follow-up period. Gender and length of education were not significant predictors of depressive symptoms.
Mobility problems and older age seem to increase the risk for developing depressive symptoms in elderly people. The risk is not associated with the level of physical activity.
To evaluate the validity and reliability of a standardized approach for assessing life-space mobility (the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA)) and its ability to detect changes in life-space over time in community-dwelling older adults.
Prospective, observational cohort study.
Five counties (three rural and two urban) in central Alabama.
Community-dwelling Medicare beneficiaries (N=306; 46% male, 43% African American) who completed in-home baseline interviews and 2-week and 6-month telephone follow-up interviews.
The LSA assessed the range, independence, and frequency of movement over the 4 weeks preceding assessments. Correlations between the baseline LSA and measures of physical and mental health (physical performance, activities of daily living, instrumental activities of daily living, a global measure of health (the short form-12 question survey), the Geriatric Depression Scale, and comorbidities) established validity. Follow-up LSA scores established short-term test-retest reliability and the ability of the LSA to detect change.
For all LSA scoring methods, baseline and 2-week follow-up LSA correlations were greater than 0.86 (95% confidence interval=0.82-0.97). Highest correlations with measures of physical performance and function were noted for the LSA scoring method considering all attributes of mobility. The LSA showed both increases and decreases at 6 months.
Life-space correlated with observed physical performance and self-reported function. It was stable over a 2-week period yet showed changes at 6 months.
There is a need for greater understanding of setting-specific influences on physical activity to complement the predominant research paradigm of individual-centered influences on physical activity. In this study, the authors used a cross-sectional multilevel analysis to examine a range of neighborhood-level characteristics and the extent to which they were associated with variation in self-reported physical activity among older adults. The sample consisted of 582 community-dwelling residents age 65 years and older (M = 73.99 years, SD = 6.25) recruited from 56 neighborhoods in Portland, OR. Information collected from participants and neighborhood data from objective sources formed a two-level data structure. These hierarchical data (i.e., individuals nested within neighborhoods) were subjected to multilevel structural-equation-modeling analyses. Results showed that neighborhood social cohesion, in conjunction with other neighborhood-level factors, was significantly associated with increased levels of neighborhood physical activity. Overall, neighborhood-level variables jointly accounted for a substantial variation in neighborhood physical activity when controlling for individual-level variables.
Through a cross-national investigation of the United States and Germany, this study examines how individual level social capital relates to the health of the elderly. Data from two national telephone surveys conducted in Germany (N=682) and the United States (N=608) with probability samples of non-institutionalized persons aged 60 and older was used. Indicators of social capital including both norms (reciprocity and civic trust) and behaviors (participation) were tested with three self-reported health indicators-overall health, depression (CES-D) and functional limitations. Housing variables and social support were controlled for in the study. Lack of reciprocity was associated with poorer self-rated health in both countries. Civic mistrust was associated with poorer self-rated health in both countries as well as with depression and functional limitations in America. Lack of participation was, in Germany, associated with poorer self-rated health and depression. The cross-national results indicate that individual-level analysis of social capital along with marco-level determinants are important for understanding the health of the elderly.
To define racial similarities and differences in mobility among community-dwelling older adults and to identify predictors of mobility change.
Prospective, observational, cohort study.
Nine hundred and five community-dwelling older adults.
Baseline in-home assessments were conducted to assess life-space mobility, sociodemographic variables, disease status, geriatric syndromes, neuropsychological factors, and health behaviors. Disease reports were verified by review of medications, physician questionnaires, or hospital discharge summaries. Telephone interviews defined follow-up life-space mobility at 18 months of follow-up.
African Americans had lower baseline life-space (LS-C) than whites (mean 57.0 +/- standard deviation [SD] 24.5 vs. 72.7 +/- SD 22.6; P < .001). This disparity in mobility was accompanied by significant racial differences in socioeconomic and health status. After 18 months of follow-up, African Americans were less likely to show declines in LS-C than whites. Multivariate analyses showed racial differences in the relative importance and strength of the associations between predictors and LS-C change. Age and diabetes were significant predictors of LS-C decline for both African Americans and whites. Transportation difficulty, kidney disease, dementia, and Parkinson's disease were significant for African Americans, while low education, arthritis/gout, stroke, neuropathy, depression, and poor appetite were significant for whites.
There are significant disparities in baseline mobility between older African Americans and whites, but declines were more likely in whites. Improving transportation access and diabetes care may be important targets for enhancing mobility and reducing racial disparities in mobility.
This study examines the relationships that exist between social isolation, support, and capital and nutritional risk in older black and white women and men. The paper reports on 1000 community-dwelling older adults aged 65 and older enrolled in the University of Alabama at Birmingham (UAB) Study of Aging, a longitudinal observational study of mobility among older black and white participants in the USA. Black women were at greatest nutritional risk; and black women and men were the groups most likely to be socially isolated and to possess the least amounts of social support and social capital. For all ethnic-gender groups, greater restriction in independent life-space (an indicator of social isolation) was associated with increased nutritional risk. For black women and white men, not having adequate transportation (also an indicator of social isolation) was associated with increased nutritional risk. Additionally, for black and white women and white men, lower income was associated with increased nutritional risk. For white women only, the perception of a low level of social support was associated with increased nutritional risk. For black men, not being married (an indicator of social support) and not attending religious services regularly, restricting activities for fear of being attacked, and perceived discrimination (indicators of social capital) were associated with increased nutritional risk. Black females had the greatest risk of poor nutritional health, however more indicators of social isolation, support, and capital were associated with nutritional risk for black men. Additionally, the indicators of social support and capital adversely affecting nutritional risk for black men differed from those associated with nutritional risk in other ethnic-gender groups. This research has implications for nutritional policies directed towards older adults.
The article reports on a multilevel analysis conducted to examine change in neighborhood walking activity over a 12-month period in a community-based sample of 28 neighborhoods of 303 older adults age 65 and over. The study employed a multilevel (residents nested within neighborhoods) and longitudinal (4 repeated measures over 1 year) design and a multilevel analysis of change and predictors of change in neighborhood walking activity. Results indicated a significant neighborhood effect, with neighborhood-level walking characterized by a downward trajectory over time. Inclusion of baseline variables using selected perceived neighborhood-level social- and physical-environment measures indicated that neighborhoods with safe walking environments and access to physical activity facilities had lower rates of decline in walking activity. The findings provide preliminary evidence of neighborhood-level change and predictors of change in walking activity in older adults. They also suggest the importance of analyzing change in physical activity in older adults from a multilevel or macrolevel framework.
The University of Alabama at Birmingham (UAB) Study of Aging Life-Space Assessment (LSA) is a relatively new instrument to measure mobility. The purpose of this report is to describe the relationships between LSA and traditional measures of physical function, sociodemographic characteristics, depression, and cognitive status.
Subjects were a stratified random sample of 998 Medicare beneficiaries aged > or =65 years. The sample was 50% African American, 50% male, and 50% from rural (versus urban) counties.
In-home interviews were conducted. Mobility was measured using the LSA, which documents where and how often subjects travel and any assistance needed during the 4 weeks prior to the assessment. Basic activities of daily living (ADL) and instrumental activities of daily living (IADL), cognitive status, income level, presence of depressive symptoms, and transportation resources were determined. The Short Physical Performance Battery (SPPB) was used to assess physical performance.
Simple bivariate correlations indicated a significant relationship between LSA and all variables except residence (rural versus urban). In a regression model, physical function (ADL, IADL) and physical performance (SPPB) accounted for 45.5% of the variance in LSA scores. An additional 12.7% of the variance was explained by sociodemographic variables, and less than 1% was explained by cognition and depressive symptoms.
The LSA can be used to document patients' mobility within their home and community. The LSA scores are associated with a person's physical capacity and other factors that may limit mobility. These scores can be used in combination with other tests and measures to generate clinical hypotheses to explain mobility deficits and to plan appropriate interventions to address these deficits.
Few studies have distinguished between the effects of different forms of social capital on health. This study distinguished between the health effects of summary measures tapping into the constructs of community bonding and community bridging social capital.
A multilevel logistic regression analysis of community bonding and community bridging social capital in relation to individual self rated fair/poor health.
40 US communities.
Within community samples of adults (n = 24 835), surveyed by telephone in 2000-2001.
Adjusting for community sociodemographic and socioeconomic composition and community level income and age, the odds ratio of reporting fair or poor health was lower for each 1-standard deviation (SD) higher community bonding social capital (OR = 0.86; 95% = 0.80 to 0.92) and each 1-SD higher community bridging social capital (OR = 0.95; 95% CI = 0.88 to 1.02). The addition of indicators for individual level bonding and bridging social capital and social trust slightly attenuated the associations for community bonding social capital (OR = 0.90, 95% CI = 0.84 to 0.97) and community bridging social capital (OR = 0.96, 95% CI = 0.89 to 1.03). Individual level high formal bonding social capital, trust in members of one's race/ethnicity, and generalised social trust were each significantly and inversely related to fair/poor health. Furthermore, significant cross level interactions of community social capital with individual race/ethnicity were seen, including weaker inverse associations between community bonding social capital and fair/poor health among black persons compared with white persons.
These results suggest modest protective effects of community bonding and community bridging social capital on health. Interventions and policies that leverage community bonding and bridging social capital might serve as means of population health improvement.