Individual and neighborhood effects on active lifestyles and social isolation in a sample of community-dwelling elderly: A socio-ecological study.

摘要

There is strong evidence that maintaining an active lifestyle into old age provides important physical and mental health benefits. Understanding the individual and neighborhood factors that facilitate or inhibit active lifestyles in this important population segment will contribute needed data toward the development of multi-level, multi-disciplinary interventions to prevent decline. The overall aim of this study was to investigate the affect of neighborhood contextual factors on activity engagement and social isolation in elderly, community-dwelling adults. Methods. Neighborhood and individual data were collected from adults, age 65 years and older, residing in distinct neighborhoods within the city and county of Denver, Colorado. Eight neighborhoods were selected to participate based upon the number of potential participants and variability with regard to neighborhood walkability, socio-economic status, proportion of adults over 65, and crime statistics. A list of patients age 65 or older was obtained from electronic medical records, geocoded, and matched to the 8 selected neighborhoods using a Geographic Information System. A randomly selected sample (N=871) from the address-matched patient list were invited by letter to participate in the study. 190 seniors completed and returned the survey, providing data regarding perceptions of their neighborhood including access to resources, safety from traffic and crime, and social cohesion. They also reported on their weekly engagement in physical and social activities, loneliness and social support. Individual health data were extracted from electronic medical charts. Environmental data on both structural and social features of each neighborhood were collected using published data as well as an environmental audit tool adapted from the Systematic Pedestrian and Cycling Environment Scan (SPACES) instrument and the Neighborhood Brief Observational Tool (NBOT ). Results. Neighborhood structural variables that maximized walking efficiency and mixed land-use significantly predicted greater walking for errands (p.05). Social capital variables were indirectly associated with more frequent community engagement, more total and moderate-level PA and less loneliness, and their effects were mediated by perceptions of safety from crime and social cohesion (p.05). Conclusions. Addressing social factors within neighborhood environments by enhancing perceptions of safety from crime and social cohesion may be just as important as providing walkable communities with convenient destinations.