Review and special article
Neighborhood Environment in Studies of Health of Older Adults: A Systematic Review

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Context

Epidemiologists and public health researchers are studying neighborhood's effect on individual health. The health of older adults may be more influenced by their neighborhoods as a result of decreased mobility. However, research on neighborhood's influence on older adults' health, specifically, is limited.

Evidence acquisition

Recent studies on neighborhood and health for older adults were identified. Studies were identified through searches of databases including PsycINFO, CINAHL, PubMed, Academic Search Premier, Ageline, Social Science Citation Index, and Health Source. Criteria for inclusion were as follows: human studies; English language; study sample included adults aged ≥55 years; health outcomes, including mental health, health behaviors, morbidity, and mortality; neighborhood as the primary exposure variable of interest; empirical research; and studies that included ≥10 neighborhoods. Air pollution studies were excluded. Five hundred thirty-eight relevant articles were published during 1997–2007; a total of 33 of these articles met inclusion criteria.

Evidence synthesis

The measures of objective and perceived aspects of neighborhood were summarized. Neighborhood was primarily operationalized using census-defined boundaries. Measures of neighborhood were principally derived from objective sources of data; eight studies assessed perceived neighborhood alone or in combination with objective measures. Six categories of neighborhood characteristics were socioeconomic composition, racial composition, demographics, perceived resources and/or problems, physical environment, and social environment. The studies are primarily cross-sectional and use administrative data to characterize neighborhood.

Conclusions

These studies suggest that neighborhood environment is important for older adults' health and functioning.

Section snippets

Background

A growing literature has reported associations between neighborhood and health behaviors and health status in the general population. As the literature expands, it is worthwhile to consider specific populations such as older adults. The world population is aging; the proportion of people aged ≥65 years is growing.1 In the U.S., the number of people aged ≥65 years will more than double from 2000 to 2030 (from 35 to 71 million).2

The neighborhood-health literature highlights associations for four

Methods

Articles for possible inclusion were identified through a search of databases (Figure 1), incorporating articles published from January 1, 1997, to December 31, 2007. The articles were identified using the search term residence characteristics in MeSH and the term neighborhood in PubMed in the title or abstract field. Prior to reviewing abstracts, the research team established inclusion and exclusion criteria. English-language empirical studies of physical and mental health outcomes (including

Identified Studies

The majority of the 33 studies (n=25) were cross-sectional; eight were longitudinal. The majority of the studies (n=26) were conducted in the U.S.; seven were conducted in Europe or Australia. Neighborhood exposures were evaluated with respect to a wide variety of health outcomes, including mortality and morbidity, self-reported health or quality of life, mental health, cognition, disability, and physical activity/BMI. The size and scale of the studies varied. For example, 24 studies

Discussion

There is modest evidence that neighborhood significantly influences the health of older adults. However, the analytic approach of many of the studies limited their ability to identify specific neighborhood factors associated with health for older adults. While the study subjects of all of the studies discussed here were aged ≥55 years, the research questions and methods did not necessarily assess or take into consideration characteristics specific to the older population, such as their physical

Conclusion

This literature review provides limited evidence that neighborhood environment is a primary influence on older adults' health and functioning. These results highlight the need for additional hypothesis-driven research based on models linking specific neighborhood exposure to health outcomes in older adults. New methods are needed to define “activity spaces”104 that are relevant to older adults and integrate direct measurement of these spaces into research. Further, relevant neighborhood

References (112)

  • K.V. Patel et al.

    Neighborhood context and self-rated health in older Mexican Americans

    Ann Epidemiol

    (2003)
  • L.L. Roos et al.

    Socioeconomic determinants of mortality in two Canadian provinces: multilevel modelling and neighborhood context

    Soc Sci Med

    (2004)
  • M.L. Booth et al.

    Social–cognitive and perceived environment influences associated with physical activity in older Australians

    Prev Med

    (2000)
  • N. Krieger

    Epidemiology and the web of causation: has anyone seen the spider?

    Soc Sci Med

    (1994)
  • C.F. Hybels et al.

    Sociodemographic characteristics of the neighborhood and depressive symptoms in older adults: using multilevel modeling in geriatric psychiatry

    Am J Geriatr Psychiatry

    (2006)
  • World population ageing 2007

  • Older Americans 2008: Key Indicators of Well-Being

    (March 2008)
  • I.H. Yen et al.

    Neighborhood social environment and risk of death: multilevel evidence from the Alameda County study

    Am J Epidemiol

    (1999)
  • L.N. Borrell et al.

    Neighbourhood characteristics and mortality in the Atherosclerosis Risk in Communities Study

    Int J Epidemiol

    (2004)
  • M. Winkleby et al.

    Effect of cross-level interaction between individual and neighborhood socioeconomic status on adult mortality rates

    Am J Public Health

    (2006)
  • M.A. Winkleby et al.

    Influence of individual and neighbourhood socioeconomic status on mortality among black, Mexican-American, and white women and men in the United States

    J Epidemiol Community Health

    (2003)
  • A.V. Diez-Roux et al.

    Neighborhood environments and coronary heart disease: a multilevel analysis

    Am J Epidemiol

    (1997)
  • F.B. LeClere et al.

    Neighborhood social context and racial differences in women's heart disease mortality

    J Health Soc Behav

    (1998)
  • G. Davey Smith et al.

    Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study

    J Epidemiol Community Health

    (1998)
  • A.V. Diez Roux et al.

    Neighborhood of residence and incidence of coronary heart disease

    N Engl J Med

    (2001)
  • C. Cubbin et al.

    Neighborhood context and cardiovascular disease risk factors: the contribution of material deprivation

    Ethn Dis

    (2001)
  • S.A. Reijneveld

    Neighbourhood socioeconomic context and self reported health and smoking: a secondary analysis of data on seven cities

    J Epidemiol Community Health

    (2002)
  • K. Sundquist et al.

    Neighborhood socioeconomic environment and incidence of coronary heart disease: a follow-up study of 25,319 women and men in Sweden

    Am J Epidemiol

    (2004)
  • K. Sundquist et al.

    Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden

    J Epidemiol Community Health

    (2004)
  • C. Cubbin et al.

    Protective and harmful effects of neighborhood-level deprivation on individual-level health knowledge, behavior changes, and risk of coronary heart disease

    Am J Epidemiol

    (2005)
  • K.D. Truong et al.

    A systematic review of relations between neighborhoods and mental health

    J Ment Health Policy Econ

    (2006)
  • M.A. Papas et al.

    The built environment and obesity

    Epidemiol Rev

    (2007)
  • B.E. Saelens et al.

    Built environment correlates of walking: a review

    Med Sci Sports Exerc

    (2008)
  • J.F. Sallis et al.

    Physical activity and food environments: solutions to the obesity epidemic

    Milbank Q

    (2009)
  • J. Bell et al.

    Why place matters: building a movement for healthy communities

    (2007)
  • M.P. Lawton

    Environment and aging

    (1986)
  • T.A. Glass et al.

    Neighborhoods, aging, and functional limitations

  • B.A. Shaw et al.

    Tracking changes in social relations throughout late life

    J Gerontol B Psychol Sci Soc Sci

    (2007)
  • C.L. Johnson et al.

    Constraints and facilitators to friendships in late late life

    Gerontologist

    (1994)
  • K. Lawler

    Coordinating housing and health care provision for America's growing elderly population

    (2001)
  • R.A. Marottoli et al.

    Consequences of driving cessation: decreased out-of-home activity levels

    J Gerontol B Psychol Sci Soc Sci

    (2000)
  • J.M. Guralnik et al.

    Maintaining mobility in late lifeI. Demographic characteristics and chronic conditions

    Am J Epidemiol

    (1993)
  • K.G. Manton

    A longitudinal study of functional change and mortality in the United States

    J Gerontol

    (1988)
  • T. van Tilburg

    Losing and gaining in old age: changes in personal network size and social support in a four-year longitudinal study

    J Gerontol B Psychol Sci Soc Sci

    (1998)
  • I.H. Yen et al.

    Women's perceptions of neighborhood resources and hazards related to chronic disease risk factors: focus group results from economically diverse neighborhoods in a mid-sized U.S. city

    Am J Health Promot

    (2007)
  • K.E. Pickett et al.

    Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review

    J Epidemiol Community Health

    (2001)
  • I.G. Ellen et al.

    Neighborhood effects on health: exploring the links and assessing the evidence

    J Urban Aff

    (2001)
  • B.E. Saelens et al.

    The importance of the built environment in older adults' physical activity: a review of the literature

    Wash State J Public Health Pract

    (2008)
  • P. O'Campo

    Invited commentary: advancing theory and methods for multilevel models of residential neighborhoods and health

    Am J Epidemiol

    (2003)
  • A.V. Diez Roux

    The study of group-level factors in epidemiology: rethinking variables, study designs, and analytical approaches

    Epidemiol Rev

    (2004)
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