Elsevier

Social Science & Medicine

Volume 73, Issue 10, November 2011, Pages 1525-1533
Social Science & Medicine

Aging in neighborhoods differing in walkability and income: Associations with physical activity and obesity in older adults

https://doi.org/10.1016/j.socscimed.2011.08.032Get rights and content

Abstract

While there is a growing literature on the relations between neighborhood design and health factors such as physical activity and obesity, less focus has been placed on older adults, who may be particularly vulnerable to environmental influences. This study evaluates the relations among objectively measured neighborhood design, mobility impairment, and physical activity and body weight in two U.S. regional samples of community dwelling older adults living in neighborhoods differing in walkability and income levels. An observational design involving two time points six months apart was employed between 2005 and 2008. U.S. Census block groups in Seattle-King County, Washington and Baltimore, Maryland-Washington DC regions were selected via geographic information systems to maximize variability in walkability and income. Participants were 719 adults ages 66 years and older who were able to complete surveys in English and walk at least 10 feet continuously. Measurements included reported walking or bicycling for errands (i.e., transport activity) and other outdoor aerobic activities measured via the CHAMPS questionnaire: accelerometry-based moderate-to-vigorous physical activity; reported body mass index; and reported lower extremity mobility impairment measured via the Late-Life Function and Disability Instrument. Across regions, time, and neighborhood income, older adults living in more walkable neighborhoods had more transport activity and moderate-to- vigorous physical activity and lower body mass index relative to those living in less walkable neighborhoods. The most mobility-impaired adults living in more walkable neighborhoods reported transport activity levels that were similar to less mobility-impaired adults living in less walkable neighborhoods. The results add to the small literature aimed at understanding how neighborhood design may influence physical activity and related aspects of health linked with day-to-day function and independence as people age.

Highlights

► Across two U.S. regions, objective neighborhood walkability predicted older adults’ physical activity irrespective of income. ► Neighborhood walkability–physical activity relations were similar using self-report and objective physical activity measures. ► Across income levels, older adults living in walkable neighborhoods weighed less than those in less walkable neighborhoods. ► Across mobility impairment level, older adults engaged in more walking or cycling for errands in more walkable neighborhoods.

Introduction

Older adults represent the most rapidly growing population segment in many industrialized nations, and are among the least physically active (de Groot, Verheijden, de Henauw, Schroll, & van Staveren, 2004). In U.S. and Swedish population studies employing objective activity measurement, fewer than 5% of adults over age 65 met physical activity recommendations (Hagstromer et al., 2010, Troiano et al., 2008). Decreases in physical activity and increases in body weight that often accompany aging are linked with deterioration of a range of physiological systems that can lead to impairments in day-to-day function. These systems are often critical to maintaining mobility, independent living, and overall quality of life (Alley and Chang, 2007, Hirvensalo et al., 2000, King and Guralnik, 2010).

Functional impairments, as well as inactivity levels, can be exacerbated by the environmental contexts in which older adults live (Clarke and George, 2005, Yen et al., 2009). For example, Clarke and George (2005) reported that older adults with reduced physical function were less able to perform daily utilitarian activities when they lived in residential neighborhoods with few destinations nearby (Clarke & George, 2005). Neighborhood opportunities to engage safely in active transport (i.e., walking or bicycling for errands) may help even mobility impaired older adults avoid further disability and dependence (Hirvensalo et al., 2000, Langlois et al., 1997).

Numerous studies of younger adults using objective measures of neighborhood walkability (i.e., higher residential density, land-use mix, street connectivity, etc., assessed using geographic information systems [GIS]) have documented consistent associations between living in neighborhoods designed to support active transport and reduced risks of inactivity, overweight, and obesity (Heath et al., 2006, Saelens and Handy, 2008, Sallis et al., 2009). Fewer such studies exist among older adults (Frank et al., 2010, King et al., 2003, Yen et al., 2009), and those that have included objective measures of the built environment have shown inconsistent results (Frank et al., 2010, King et al., 2005, Yen et al., 2009). Studies of older adults have rarely included objective measures of physical activity (i.e., accelerometry), and, to our knowledge, only two studies have reported obesity outcomes in older adults (Berke et al., 2007, Frank et al., 2010).

The purpose of the study was to evaluate the relations among objectively measured neighborhood design, mobility impairment, and physical activity and body weight in two U.S. regional samples of community dwelling older adults living in neighborhoods differing in walkability and income levels. Outcomes of interest were walking/cycling for transport, given its potential relation with aging in place (Langlois et al., 1997), objectively measured moderate to vigorous physical activity which has been linked consistently to health outcomes associated with aging, and reported body mass index. The potential moderating effect of mobility impairment on these relations was explored.

Section snippets

Study design

The Senior Neighborhood Quality of Life Study was an observational study designed to compare physical activity and other health and well being outcomes among older residents of neighborhoods stratified on objectively derived ‘walkability’ characteristics and median household income. Based on the study design and methods used in the Neighborhood Quality of Life Study targeting younger adults (Sallis et al., 2009), data were collected from 2005 to 2008 in the Seattle-King County, Washington and

Participant characteristics and representativeness

A total of 3359 eligible adults living in the selected block groups were contacted by telephone and invited to participate. Study enrollment rate (i.e., returned Survey 1/eligible contacts) was 21.4% overall (n = 719, with 363 from Seattle and 356 from Baltimore regions), and did not differ significantly by region or by quadrant (quadrant range of 17.7%–25.1%). The 6 month retention rate was 91% overall (n = 647, with 319 from Seattle region and 328 from Baltimore region) (quadrant range of

Discussion

Objectively measured neighborhood walkability was related to older adults’ self-reported and accelerometer-derived physical activity as well as BMI. Of particular note, residents of higher walkable neighborhoods reported 22–40 more minutes/week of active transport than those in lower walkable neighborhoods, irrespective of neighborhood income. This replicates a pattern commonly found in younger adults (Saelens & Handy, 2008), but which has been less well studied among older populations (Frank

Conclusions

This study expands the built environment and aging literature by studying older adults from two U.S. regions using a study design that maximized variation in walkability and income and featured objective measures of the built environment and physical activity. Though older adults had very low levels of physical activity, regardless of measure, living in more walkable neighborhoods was associated with more active transport and moderate to vigorous physical activity and lower body weight

Acknowledgments

The research was supported by U.S. National Heart, Lung, & Blood Institute grant R01 HL077141 awarded to the first author. The sponsor had no role in the preparation, review, or approval of the manuscript for publication. The authors thank Carrie Geremia, BA, for assistance in data collection protocols; Vincent Learnihan, for assistance in developing walkability and built environment measures; Matthew Buman, PhD and Eric Hekler, PhD for assistance with data analysis and manuscript review; Jack

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