Disablement in Context: Neighborhood Characteristics and Their Association With Frailty Onset Among Older Adults

Abstract

Objectives Frailty, an aggregate expression of risk resulting from age- or disease-associated physiologic accumulation, is responsible for large economic and societal costs. Little is known about how the context in which older adult’s live may contribute to differences in frailty. This study clarifies the role of neighborhood structural characteristics and social processes for understanding declines in health status. Method Data from two waves of the National Social Life, Health and Aging Project were linked to tract-level information from the 2000 Census (n = 1,925). Frailty was measured with in-home assessments and self-report. Ordered logistic regressions were employed to estimate the role of tract-level structural and social process indicators at baseline on frailty at follow-up. Results Living in a neighborhood characterized with a higher density of African Americans and with more residential instability was associated with higher odds of frailty. Adults in neighborhoods with increasing levels of physical disorder had higher odds of frailty (adjusted odds ratio [AOR]: 1.20, 95% confidence interval [CI]: 1.03, 1.39), while those exposed to more social cohesion had lower odds (AOR: 0.87, CI: 0.78, 0.97). Discussion For older adults, both neighborhood structural and social process characteristics appear to be independently associated with frailty.

Built Environment and Frailty: Neighborhood Perceptions and Associations With Frailty, Experience From the Nagoya Longitudinal Study

“…Nonetheless, other factors must come into play in the associations between neighborhood environment and frailty. In Caldwell's study of socio, cultural, and physical aspects of the neighborhood environment and frailty in the United States, perceptions of worsening social cohesion were also associated with an increased incidence of frailty over 5 years (Caldwell et al, 2017). This poorer perception of social cohesion and belonging, allied with worse perceived personal safety, were also found to be determinants of increased frailty levels in Dutch communities (Cramm & Nieboer, 2013); with the hypothesis being that increasing frailty levels impact on levels of outdoor activity and restrict social interactions within the neighborhood, thus contributing negatively to frailty status.…”

“…Yu’s (Yu et al, 2018) longitudinal study confirmed that objectively assessed proximity to green spaces was associated with improvement of frailty phenotype in Chinese older people (Yu et al, 2018). The perception of poor neighborhood physical disorder, defined as the deterioration of buildings and other visible characteristics, was associated with a higher incidence of phenotypic frailty in a longitudinal study (Caldwell et al, 2017). Another cross-sectional study in China reported that perceptions of the neighborhood environment aesthetic quality and an overall walking environment were associated with less frailty as measured by the FRAIL scale (Ye et al, 2018).…”

Is life-course neighbourhood deprivation associated with frailty and frailty progression from age 70 to 82 in the Lothian Birth Cohort 1936?

“…Structural differences across neighbourhoods, including social deprivation, can be linked to frailty via the stress pathway or through variations in providing collective resources and opportunities to residents to support their health and wellbeing. [31][32][33][34] Living in socially deprived neighbourhoods may affect health and frailty, by accumulation of stress over time. A recent investigation demonstrated that long-term exposure to deprived neighbourhoods is associated with worse allostatic load: wear and tear on the body likely linked to chronic psychological stress exposure.…”

“…social cohesion, social participation) are protective against frailty by creating and maintaining social connections and support networks, and by buffering stress. 31,32,34,35 Availability of recreational and cultural facilities has been associated with slower age-related decline. 36 While perceiving residential areas as unsafe 32 or deteriorating 31 are associated with frailty, likely via higher stress levels, avoidance behaviour and maladaptive coping mechanisms, 31,37 greater access to green space could stimulate engagement in physical and social activities, improving frailty status.…”

“…31,32,34,35 Availability of recreational and cultural facilities has been associated with slower age-related decline. 36 While perceiving residential areas as unsafe 32 or deteriorating 31 are associated with frailty, likely via higher stress levels, avoidance behaviour and maladaptive coping mechanisms, 31,37 greater access to green space could stimulate engagement in physical and social activities, improving frailty status. 38 However, understanding why neighbourhood-based inequalities in frailty persisted among males during almost the entire follow-up period (age 70-82) of the study but only first materialised at age 70.5 for females, needs further exploration, and might be linked to the role of neighbourhood resources and stressors across the life course.…”