Neighborhood effects for aging in place: a transdisciplinary framework toward health-promoting settings

Gan, Daniel Rong Yao

doi:10.1080/08882746.2017.1393283

Cited by 22 publications

(16 citation statements)

References 92 publications

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“…Future research may seek to understand plausible mechanisms by examining qualitative data of participants’ lived experiences and comparing across profiles. Community-level structural variables (e.g., neighborhood socioeconomic status) may alter individual experiences of the COVID-19 syndemic pandemic [ 20 , 47 , 48 , 49 ]. Qualitative methods are appropriate to “understand social processes or social structures … the settings, groups or individuals … which cannot be pre-selected” otherwise [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Prior Social Contact and Mental Health Trajectories during COVID-19: Neighborhood Friendship Protects Vulnerable Older Adults

Gan

Best

2021

IJERPH

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Social networking protects mental health during a crisis. Prior contact with social organizations, friends, and non-friend neighbors may be associated with better trajectories of loneliness, depression and subjective memory during COVID-19. Regression analysis was conducted using longitudinal data from a representative sample of n = 3105 US adults aged ≥55 in April–October 2020. Latent profile analysis was also conducted. Prior contact with friends (B = −0.075, p < 0.001), neighbors (B = −0.048, p = 0.007), and social organizations (B = −0.073, p < 0.001) predicted for better mental health during COVID-19. Three profiles were identified: Profile 1 had the best outcomes, with prior contact with social organizations (B = −0.052, p = 0.044) predicting decreasing loneliness. For Profile 2, prior ‘meeting’ contact with friends predicted decreasing loneliness (B = −0.075, p < 0.001) and better subjective memory (B = −0.130, p = 0.011). Conversely, prior contact with neighbors (B = −0.165, p = 0.010) predicted worsening loneliness among Profile 3. The COVID-19 pandemic has had a differential impact on the mental health trajectories of aging adults with social ties of different strengths. Stronger neighborhood networks are important to mitigate poor mental health outcomes among vulnerable older adults during a crisis. Older adults who are living alone and had relied on non-friend neighbors for social connectedness require additional community supports. Policy interventions are required to mitigate the mental health impact of future pandemics.

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Section: Discussionmentioning

confidence: 99%

Prior Social Contact and Mental Health Trajectories during COVID-19: Neighborhood Friendship Protects Vulnerable Older Adults

Gan

Best

2021

IJERPH

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“…20,24 Disparities related to nSES may actually worsen for older adults over time because of the shrinking of their effective neighborhoods as they lose mobility with increasing age. [24][25][26] nSES may also reflect the social (eg, sociocultural norms, distrust of the health system) and/or physical environment (eg, community-based organizations promoting ACP) distinct to a neighborhood. 24 Alternatively, it is possible that the association between nSES and ACP is driven by individual-level SES; however, we could not ascertain individual-level SES from the EHR.…”

Section: Discussionmentioning

confidence: 99%

“…7 ACP is a complex, socially mediated behavior 18,19 ; thus, as with other socially mediated health behaviors, such as physical activity, blood pressure management, and tobacco use, [20][21][22] it is likely that community-level factors influence ACP. More specifically, neighborhood socioeconomic status (nSES) has been associated with myriad health behaviors and social ties, 20,23 among older adults in particular, [24][25][26][27][28] and may therefore also be associated with ACP. Understanding community patterns of health behaviors, such as ACP, allows development of multilevel interventions, including targeted program delivery to areas with highest need and greatest disadvantage.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Neighborhood Socioeconomic Characteristics and Advance Care Planning Among Older Adults

et al. 2020

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IMPORTANCE Advance care planning (ACP) is low among older adults with socioeconomic disadvantage. There is a need for tailored community-based approaches to increase ACP, but community patterns of ACP are poorly understood. OBJECTIVETo examine the association between neighborhood socioeconomic status (nSES) and ACP and to identify communities with both low nSES and low rates of ACP. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study examined University of California San Francisco electronic health record (EHR) data and place-based data from 9 San Francisco Bay Area counties. Participants were primary care patients aged 65 years or older and living in the San Francisco Bay Area in July 2017. Statistical analysis was performed from May to June 2020. EXPOSURES Patients' home addresses were geocoded and assigned to US Census tracts. The primary factor, nSES, an index combining area-level measures of income, education, poverty, employment, occupation, and housing or rent values, was divided into quintiles scaled to the distribution of all US Census tracts in the Bay Area (Q1 = lowest nSES). Covariates were from the EHR and included health care use (primary care, outpatient specialty, emergency department, and inpatient encounters in the prior year). MAIN OUTCOMES AND MEASURESACP was defined as a scanned document (eg, advance directive), ACP Current Procedural Terminology code, or ACP note type in the EHR. RESULTS There were 13 104 patients included in the cohort-mean (SD) age was 75 (8) years, with 7622 female patients (58.2%), 897 patients (6.8%) identified as Black, 913 (7.0%) as Latinx, 3788 (28.9%) as Asian/Pacific Islander, and 748 (5.7%) as other minority race/ethnicity, and 2393 (18.3%) self-reported that they preferred to speak a non-English language. Of these, 3827 patients (29.2%) had documented ACP. The cohort was distributed across all 5 quintiles of nSES (Q1: 1426 patients

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“…Mental and functional health were chosen as relevant goals of place-based, age-friendly interventions [ 3 ]. With reference to the Transdisciplinary Neighborhood Health Framework [ 32 ] and other studies [ 16 , 24 , 33 ], we hypothesize that neighborhood cohesion mediates between active living and mental health. We define neighborhood cohesion as the depth and breadth of social ties in a local area, regardless of societal fault lines.…”

Section: Introductionmentioning

confidence: 99%

Neighborhood Makes or Breaks Active Ageing? Findings from Cross-Sectional Path Analysis

Gan

Cheng

et al. 2022

IJERPH

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Mental ill-health prolongs and complicates other chronic illnesses, which is a major public health concern because of the potential stress it places on health systems. Prevention via active aging and place-based interventions thus became increasingly important with population aging, e.g., through health promotion and age-friendly neighborhoods. However, how the targeted outcomes of these efforts are related remains unclear. This paper examined whether the relationship between active living and mental health or health-related quality of life is mediated by neighborhood cohesion. Cross-sectional data were drawn from n = 270 community-dwelling adults aged 50 and above in the Gerontology Research Program—Center for Ageing Research in the Environment (GRP-CARE) Survey. Path analysis showed that one can live actively for better mental health (Btotal = 0.24), but it is largely mediated by neighborhood cohesion (37%). Further examination of the factors of neighborhood cohesion showed that this mediation is explained by communal affordance (Bindirect = 0.05) and neighborhood friendship (Bindirect = 0.05). Additional study of the association between these mediators and factors of mental health revealed two psychosocial processes: (1) better community spaces (e.g., greenery and third places) support communal living (B = 0.36) and help older adults obtain emotional support (B = 0.32) for greater autonomy (B = 0.25); (2) spending more time outdoors enhances neighborhood friendship (B = 0.33) and interpersonal skills (B = 0.37), which in turn improves coping (B = 0.39). In short, the effects of active living on health are limited by one’s neighborhood environment. Neighborhood cohesion must be considered or it may stifle individual and policy efforts to age actively and healthily in urban environments. Context-sensitive implementations are required.

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Neighborhood effects for aging in place: a transdisciplinary framework toward health-promoting settings

Cited by 22 publications

References 92 publications

Prior Social Contact and Mental Health Trajectories during COVID-19: Neighborhood Friendship Protects Vulnerable Older Adults

Prior Social Contact and Mental Health Trajectories during COVID-19: Neighborhood Friendship Protects Vulnerable Older Adults

Evaluation of Neighborhood Socioeconomic Characteristics and Advance Care Planning Among Older Adults

Neighborhood Makes or Breaks Active Ageing? Findings from Cross-Sectional Path Analysis

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