Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

The Urban Built Environment and Mobility in Older Adults: A Comprehensive Review

The Urban Built Environment and Mobility in Older Adults: A Comprehensive Review SAGE-Hindawi Access to Research Journal of Aging Research Volume 2011, Article ID 816106, 10 pages doi:10.4061/2011/816106 Review Article The Urban Built Environment and Mobility in Older Adults: AComprehensive Review Andrea L. Rosso, Amy H. Auchincloss, and Yvonne L. Michael Department of Epidemiology and Biostatistics, Drexel University School of Public Health, 1505 Race Street, Mail Stop 1033, Bellet 6th Floor, Philadelphia, PA 19102, USA Correspondence should be addressed to Andrea L. Rosso, alr44@drexel.edu Received 16 December 2010; Accepted 3 May 2011 Academic Editor: Thomas R. Prohaska Copyright © 2011 Andrea L. Rosso et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Mobility restrictions in older adults are common and increase the likelihood of negative health outcomes and premature mortality. The effect of built environment on mobility in older populations, among whom environmental effects may be strongest, is the focus of a growing body of the literature. We reviewed recent research (1990–2010) that examined associations of objective measures of the built environment with mobility and disability in adults aged 60 years or older. Seventeen empirical articles were identified. The existing literature suggests that mobility is associated with higher street connectivity leading to shorter pedestrian distances, street and traffic conditions such as safety measures, and proximity to destinations such as retail establishments, parks, and green spaces. Existing research is limited by differences in exposure and outcome assessments and use of cross-sectional study designs. This research could lead to policy interventions that allow older adults to live more healthy and active lives in their communities. 1. Introduction enacted function—what an individual does do [12]. In this way, assessments of an individual’s walking behavior Mobility limitations are defined by impairment or depen- represent an enacted form of mobility while questions that dence in movement and affect between one third and one assess an individual’s perception of their ability represent half of adults aged 65 or older [1]. Mobility limitations can functional capacity. Both may be relevant measures of affect an individual’s health through a number of pathways. mobility. Lack of physical activity in older individuals can lead to Mobility restrictions are not typically the result of a loss of muscle mass (sarcopenia), loss of bone density single cause, but arise from an interaction of risk factors (osteoporosis), and an increase in fat mass (obesity) [2, in various domains, both individual and environmental 3]. Isolation and loss of social ties resulting from reduced [1]. Traditionally, disability research had been based on mobility can lead to depression and other adverse mental the medical model in which the focus is on the individual health outcomes [4]. A lack of access to resources such and pathology [13]. More recently, following on the work as fresh foods and medical care which can result from of Lawton [14, 15], Verbrugge and Jette [16], and the limited mobility can also have negative impacts on health [5]. World Health Organization’s International Classification of Individuals with mobility limitations are also at higher risk Functioning, Disability, and Health (ICF) [17], disability of health service utilization [6–8] and institutionalization models have focused on the interaction of the individual [6, 9, 10]. Ultimately, further frailty and disability and with their environment. Lawton stressed the importance an increased risk of premature mortality can result from of the environment in determining the well-being of older restricted mobility [1, 11]. adults where an individual’s competence to deal with their Methods of assessing mobility limitations vary [1]. In environment combines with the stresses, or press, that the assessment of mobility, it is important to distinguish between environment places on that individual [14]. Thus, Lawton’s capacity to function—what an individual could do—and model adds the possibility that mobility may be enhanced 2 Journal of Aging Research through environmental buoys as compared to the medical Use of self-reported measures of the environment is model that assumes decline [5]. Both the ICF and Verbrugge common in the existing literature but relies on participant’s perception of problems rather than actual presence of stress the importance and bidirectionality of environmental as well as personal factors on individual health [16, 17]. barriers. Evidence consistently shows differences between objective and perceived measures of the local environment Environmental characteristics are hypothesized to limit or [19, 24]. The two measurement types are likely capturing dif- promote an individual’s ability to complete purposeful ferent constructs both of which are important in determining actions and fulfill role expectations, affecting physical func- mobility of older adults. We focus on objective measures tioning and disability (see Figure 1). here in an attempt to summarize the direct effects of built Olderadults maybemorevulnerabletoinfluenceof environment factors as these can be ideal targets for public their residential environment as they tend to travel outside policy interventions. their own neighborhoods less often than do younger adults The goal of this paper is to summarize the recent and children who travel for work and school and tend published literature on objective measures of the built to have a longer duration of exposure to neighborhood environment and mobility or disability in older adults and influences than younger individuals [5]. Declining physical provide a critical analysis of the limitations. and mental health, shrinking social networks, loss of social support, and increased fragility may also reduce the ability of older individuals to cope with environmental demands 2. Methods [5, 19, 20]. Therefore, neighborhood environment likely has a greater impact on the elderly than on those in other age Searches of Medline and Web of Science were conducted for groups and evidence suggests that supportive environments English-only articles published between 1 January, 1990 and improve quality of life in older adults [21]. Lawton proposed 7 December, 2010 with the following keyword search terms: several dimensions of environment that are important neighborhood, built environment, or physical environment and elderly, older adults, aging, mobility, disability, walking, for older adults: personal environment (family, friends), or physical function. Additional articles were identified suprapersonal environment (i.e., neighborhood racial or age through consultation with experts and review of reference composition), social environment (norms or values related lists of included articles. Inclusion criteria were (1) the to society or culture), and physical environment (e.g., built study population consisted of community-dwelling adults environment) [14]. The built environment is defined as the aged 60 years or older or if no range was provided, the human-made or human-altered space in which individuals average age was ≥65 years, (2) built environment was live out their daily lives [22] and is the focus of this paper. objectively measured either through use of administrative Much of the existing research regarding neighborhoods datasets or research rater assessments, (3) outcomes included and health has been conducted in younger or middle-aged measures of mobility or disability and physical functioning adults and has focused on aspects of the environment other as described in Verbrugge’s disablement model [16]. Articles than the physical or built environment [19, 20, 23]. The were excluded if they were a review or commentary or if they built environment’s effect on health has been conceptualized provided qualitative data only. into three domains: transportation systems which include street networks and transit systems, land use patterns which includes density and land-use mix, and urban design 3. Results which includes safety, attractiveness, and site design [18]. Transportation systems are defined as the network of physical We reviewed 31,596 abstracts for relevancy to this paper. infrastructure, such as its street network, transit systems, and Of these, 28 articles were reviewed for inclusion criteria, trails (e.g., for jogging or biking,). Transportation systems with seventeen articles meeting our criteria. Details of influence how easy it is to travel through a neighborhood these studies are provided in Table 1. Four studies were and get to places a person wants to go. Land use patterns longitudinal [25–28]; the remainder assessed cross-sectional reflect where and how residential, commercial, and industrial associations. One study used nationally representative data uses are distributed in a neighborhood. Density of land from the USA [25] and one was conducted outside the USA use represents an increased compactness of neighborhoods [29]. Seven of the studies (41%) were conducted in the with easier access to pedestrian destinations. Urban design Pacific Northwest [28, 30–35]. Enacted function, or walking characteristics—such as number and width of trafficlanes, in some form, was the most commonly assessed outcome, size and extensiveness of sidewalks, traffic calming devices— though there was little overlap in the way in which walking influence safety and attractiveness and ultimately decisions was assessed. Walking has been measured as specifically for about whether or not to walk. Pleasant pedestrian environ- exercise [35], for utilitarian purposes [30, 36], by frequency ments that promote feelings of belonging to a neighborhood of neighborhood walking on a Likert scale [32–34], by and trust in ones neighbors can be created through positive whether individuals met physical activity recommendations urbandesign[18]. In contrast, evidence of decay, such as for walking (>150 hours/week) [27, 29, 37], and by other vandalism and poorly maintained vacant lots, can reduce measures of walking frequency [3, 28, 31]. One study used mobility by creating feelings of discomfort in one’s neigh- accelerometers to directly measure the number of steps borhood. All three of these domains can potentially impact taken by participants in a day [38]. There were also a wide mobility in the elderly (see Figure 1). range of definitions for neighborhood, including specified Journal of Aging Research 3 Built Land use Transportation Urban design environment systems patterns Functional Pathology Impairments limitations Disability (including mobility) Individual factors Built environment Transportation systems: street network, transit systems Land use patterns: density, land-use mix Urban design: safety, attractiveness, site design Disablement pathway Pathology: disease or injury Impairments: dysfunction in body systems Functional limitations: restrictions in purposeful actions including mobility and enacted forms of walking Disability: difficulty performing expected activities and roles Individual factors: gender, age, health conditions, financial resources, etc. Figure 1: The role of the built environment in the disablement process (adapted from Verbrugge and Jette, 1994 [16] and Frank et al., 2003 [18]). distances from an individual’s home (i.e., quarter-mile transit, was not associated with walking in two studies radius), census tracts, and other administratively defined [29, 31]. Street connectivity, indicating shorter blocks with neighborhoods. Subgroup analyses were completed in only 5 more intersections and resulting in easier pedestrian links studies, including gender [35], lower body functional status between two points, have been studied in relation to walking [37, 39], age [25], and neighborhood socioeconomic status in older adults with mixed results. Nagel and colleagues and [28]. Fewer than half of the studies explicitly stated the Satariano and colleagues found no association [31, 37], Li theoretical framework or causal model that guided their and colleagues found a positive association [33], and Gomez research in the article [26, 28, 30, 34, 37–39]. Effect sizes and colleagues found an unexpected negative association tended to be small: approximately three-quarters of the [29]. Differences in study site, neighborhood definitions, statistically significant estimates had relative risks or odds and operationalization of walking likely accounted for some ratios below 2.0 (range was 1.08 to 4.12). differences in results for street connectivity. Neighborhoods were specified differently in the four studies: those studies finding no association, Nagel et al. [31] and Satariano et al. 3.1. Transportation Systems. Traffic-related street charac- [37], used a specified distance from homes, Li et al. [33] teristics have been assessed in relation to mobility, with used city-defined neighborhoods, and Gomez et al. [29] high-traffic volume positively associated with walking [31]. used neighborhoods defined by socioeconomic status. Two However, presence of through routes, representing high- discordant studies were conducted in the same city (Nagel traffic volume, was not associated with disability [40]. A high et al. [31]and Li et al.[33]) and another two discordant percentage of car commuters, indicating a greater reliance on studies both assessed walking as meeting physical activity driving rather than walking for transportation, was positively recommendations (Satariano et al. [37] and Gomez et al. associated with increased walking difficulty among those [29]). aged 75 and older, but not among younger age groups [25]. Living within a specified area of Bogota, ´ Columbia in which streets are closed to vehicular traffic on Sundays and holidays, 3.2. Land Use Patterns. Housing density was associated with creating a pedestrian corridor, was positively associated with greater levels of walking [33] and with less disability among walking among older residents [29]. Proximity to walking those with lower body functional limitations [39]. However, paths and trails was associated with amount of daily walking population density was not associated with increased walking [38] but not with frequency of neighborhood walking [32]. difficulty over 15 years [25]. Mix of land use, representing Finally, presence of nearby transit stops, providing access proximity to a variety of destinations such as places of em- to areas outside the immediate neighborhood via public ployment and retail establishments, has been assessed in 4 Journal of Aging Research Table 1: Details of reviewed articles of built environment characteristics and mobility in those aged 60 years and older. Associations Neighborhood Age range or Built environment Expected Unexpected Reference Sample Size Location definition Outcomes Null mean (SD) measures direction direction (n units) Census tracts Beard et al., 2009 [40] 937,857 New York, New York 65+ Mixed land use Disability X (2,138) Neighborhood Disability X decay Through routes Disability X Poor street Disability X characteristics Walkability index 100, 500, or including residential Berke et al., 2007 [35] 1967 Seattle, Washington 65–97 1000 meters Walking X and commercial from homes density Physical Mean = 78.5 Participant’s Front entrance functioning after X Brown et al., 2008 [26] 273 Miami, Florida (NR) block characteristics 24 months Mean = 73.55 Census tracts Housing density Disability X Clarke & George, 2005 [39] 4154 North Carolina (6.72) (95) Land use diversity X Results for: Increase in walking Census tracts Clarke et al., 2009 [25] 1821 USA 65–74 and Population density difficulty over 15 X (1821) 75+ years Non-automobile commuters 64–94; Mean City defined Fisher et al., 2004 [34] 582 Portland, Oregon = 73.99 neighborhoods Parks Walking X (6.25) (56) Walkability index including land use 1kilometer Frank et al., 2010 [3] 1970 Atlanta, Georgia 65+ mix, residential Walking X from homes density and street connectivity 60–98; Researcher Lives in weekend Gomez et al., 2010 [29] 1886 Bogota, ´ Columbia Mean= 70.7 defined by SES pedestrian-only Walking X (7.7) (50) corridor Transit stops X Parks X Connectivity X Mean = 69.8 1kilometer Paths Walking X Hall & McAuley, 2010 [38] 128 Illinois (5.89) from homes Parks X Journal of Aging Research 5 Table 1: Continued. Associations Neighborhood Age range or Built environment Expected Unexpected Reference Sample Size Location definition Outcomes Null mean (SD) measures direction direction (n units) Recreation areas X Exercise/gym facilities Schools X City defined Mean = 74.2 Sidewalk neighborhoods Walking X King, 2008 [36] 190 Denver, Colorado (5.8) functionality (8) Safety from traffic X Aesthetics X Destinations X Walking—cross- Mean=70 County (448) Sprawl sectional X Lee et al., 2009 [27] 4997 USA (NR) analysis Increase in walking over 5 years City defined Mean = 74 Residential Li et al., 2005 [33] 582 Portland, Oregon neighborhoods Walking X (6.3) households (56) Places of employment Street intersections X Green space and recreational facilities City defined Mean = 75.1 Michael et al., 2006 [32] 105 Portland, Oregon neighborhoods Shopping mall Walking X (6.3) (10) Trails X Sidewalk presence X Sidewalk condition X Graffiti/vandalism X 1/8, 1/4, and 1/2 Increase in walking Michael et al., 2010 [28] 422 Portland, Oregon Median = 74 mile from Parks over 3–6 year X homes follow-up Trails X Recreational facilities Mean = 74.5 1/4 or 1/2 mile Automobile traffic Nagel et al., 2008 [31] 546 Portland, Oregon Walking X (6.3) from homes volume Sidewalk coverage X 6 Journal of Aging Research Table 1: Continued. Associations Neighborhood Age range or Built environment Expected Unexpected definition Outcomes Null Reference Sample Size Location mean (SD) measures direction direction (n units) Intersection frequency Public transportation X access Retail establishments Park/green space X New Urbanism Index including mix Patterson & Chapman, 2004 [30] 133 Portland, Oregon 70–92 Census tract (6) Walking X use, connectivity and aesthetics Within 400 Common Satariano et al., 2010 [37] 884 4 USA locations 65+ Walking X meters of homes destinations Street connectivity X Commercial/mixed use neighborhood From administrative databases unless otherwise indicated. From fully adjusted models when multiple results provided. From rater assessments. Among those living in same residence for ≥2 years, positive association was found only among women. Positive association was found only among those with lower body impairments. Positive association was found only among those aged 75 and older. Positive association was found only among those in high socioeconomic neighborhoods. Locations include Alameda County, CA; Allegheny County, PA; Cook County, IL; and Wake and Durham Counties, NC. NR: not reported. Journal of Aging Research 7 several studies with inconsistent results. More mixed land automobiles for transportation. Urban sprawl measured by use was negatively associated with walking in one study [37], census data was negatively associated with walking in cross- negatively associated with disability among those with lower sectional analysis, but no association was found between body limitations in another [25], and unassociated with movement to an area classified as more or less sprawling and disability in a third [40]. change in walking behavior [27]. Neighborhood walkability Proximity to particular destinations has been widely scores have included land use mix, residential density, street assessed as a promoter of mobility among older adults. connectivity, park and trail presence, and vehicular traffic Presence of destinations may increase mobility by providing information. Frank and colleagues demonstrated a positive locations for recreational walking or by providing access to association between their walkability score and walking needed services such as grocery stores. No associations have [3], whereas Berke and colleagues found a positive asso- been found between walking and presence of recreational ciation only among women [35]. Patterson and Chapman facilities [28, 38], gyms [38], or schools [38]. In contrast, developed a scale that combines elements of urban sprawl shopping malls and overall retail destinations have been and walkability and found it was positively associated with associated with walking [31, 32]. More general measures walking among older adults in their study [30]. Another of destinations have been used, including a measure of study reported negative street characteristics, defined as low total places of employment which was positively associated density of intersections, few shade trees and few transit stops, with walking [33] and two separate measures of select were associated with greater disability [40]. destinations, including places such as retail businesses and parks, neither of which was associated with walking [36, 37]. 4. Conclusions 3.3. Urban Design. Front entrance characteristics that pro- The evidence provides empirical support for an association mote social interactions, such as presence of a stoop and between aspects of the built environment and mobility in a shallow housing setback, were positively associated with older adults. This paper suggests that built environment physical functioning among older adults in a Hispanic characteristics from three domains (transportation systems, neighborhood [26]. Neighborhood decay, represented by land use patterns, and urban design) can impact both presence of graffiti or vandalism, was not associated with functional limitations and disability in positive and negative disability [40]. Graffiti or vandalism was associated with directions. However, it is still unclear if these associations less walking in one study [36] but not associated in an- represent direct influences on the disablement process. other [32]. Differences in results for the two walking studies The most promising evidence points to high density of cannot be attributed to size of the studies or to assess- intersections, street and traffic conditions, and proximity ment of neighborhood as these were similar for both to select destinations and green space as the most likely studies. However, the study finding no association evaluated factors to impact mobility, though results have been incon- walking as frequency of any neighborhood walking and the sistent. These inconsistencies are likely due to differences in one reporting a positive association measured walking for methodology. There are many differences between studies errands only. Neither presence nor condition of sidewalks regarding neighborhood definition, exposure measurements, was associated with walking in several studies [31, 32, 36] and outcome assessment. but presence of safety measures for pedestrians against traffic Theoretical and methodological limitations are present was associated with walking [36]. Presence of parks has been in much of the existing literature on this topic. A num- positively associated with walking in two studies [33, 34], ber of papers lacked an explicit theoretical framework to but no association was found in three others [29, 31, 38]. guide determination of which neighborhood factors may These inconsistencies may be a result of different localities, impact mobility, at what spatial resolution effects should differences in neighborhood definitions, or differences in be assessed, and which individual and neighborhood level outcomes assessments as these all differed between those with factors should be considered as confounders or mediators positive findings and those with findings of no association. [19, 23, 41]. A majority of the existing literature is cross- Michael and colleagues demonstrated a positive association sectional, making causal inferences impossible [19, 20, 22, between proximity to parks or paths and increases in walking 24]. It is unknown whether individuals adapt their mobility over a 3–6-year period among men living in neighborhoods based on environmental presses and buoys or whether they classified as having high socioeconomic status but not among choose neighborhoods with fewer environmental demands those living in low socioeconomic status neighborhoods as their potential mobility decreases. However, there is some [28]. evidence that an effect of built environment on walking persists even after accounting for selection factors [42]. 3.4. Composite Scores. For some study questions, a theoreti- It is unlikely that built environment characteristics affect cal framework was used to guide the development of a built all neighborhood residents in the same manner [19, 24]. environment summary score. If the items in the summary Assessing subpopulations among older adults may prove score are similarly correlated with mobility, it may provide a important as the socially disadvantaged among them— more robust exposure than a single measure. Urban sprawl women, minorities, and those with low income—may be represents density of land use with more sprawling areas more vulnerable to environmental factors and have a higher often having poorer accessibility and greater reliance on propensity to live in disadvantaged neighborhoods [5, 20]. 8 Journal of Aging Research In addition, results should be replicated in different localities in previous research. In general, effect sizes of associations as the existing research has been limited in its geographic between built environment characteristics and functioning scope and it is unclear if differences may be due to unique in older adults are small to moderate. However, a large per- characteristics of a locality. Greater use of nationally repre- centage of the population is exposed to these conditions, sentative data may help to confirm results and assess effect indicating that the potential public health impact of policy modification by location, although these studies may suffer interventions could be great [48]. The advantage of popula- from less detailed measures of the built environment. tion level interventions over those that target only high-risk Finally, this research field would benefit from use of individuals has been demonstrated [49, 50]. In general, older broader measures of enacted mobility. This paper has iden- adults wish to age in place, remaining in their homes rather tified walking measures as the primary measure of mobility; than moving to potentially more accommodating locations however, general mobility may be more important than [51]. In order to facilitate aging in place and maintaining walking, specifically. Use of assistive devices, public trans- quality of life as people age, it is important to understand portation, and personal automobiles allow for increased the role of the built environment on mobility limitations and mobility and access to services such as healthcare and health- disability while addressing the limitations of the current body y foods [1]. General mobility assessments are available, of evidence. such as the University of Alabama Birmingham Life-Space Assessment [43, 44]. Life-space is defined as the spatial References area traveled by an individual in their daily life over a specified period of time. The Life-Space Assessment assesses [1] S. C. Webber, M. M. Porter, and V. H. Menec, “Mobility in extent of movement in the past month, how frequently older adults: a comprehensive framework,” The Gerontologist, that movement occurred, and whether assistance was used vol. 50, no. 4, pp. 443–450, 2010. [43]. New technologies are also allowing objective measures [2] L. DiPietro, “Physical activity in aging: changes in patterns of mobility through use of individual global positioning and their relationship to health and function,” The Journals of system (GPS) monitors [45]. GPS monitors do not rely on Gerontology. Series A, vol. 56, no. 2, pp. 13–22, 2001. individual recall, allow assessment of individual trips into [3] L. Frank, J. Kerr, D. Rosenberg, and A. King, “Healthy aging and where you live: community design relationships with the community, and can provide information on specific physical activity and body weight in older Americans,” Journal location and speed of movement [45]. of Physical Activity and Health, vol. 7, supplement 1, pp. S82– The current review is limited in that it addresses only S90, 2010. objective measures of the built environment. While objective [4] P. Lampinen and E. Heikkinen, “Reduced mobility and phys- characteristics are more relevant to policy interventions [19], ical activity as predictors of depressive symptoms among perceived measures capture important information about an community-dwelling older adults: an eight-year follow-up individual’s relationship with their environment. Perceived study,” Aging Clinical and Experimental Research, vol. 15, no. environmental measures can more easily assess quality and 3, pp. 205–211, 2003. access to resources within the built environment that are [5] T. A. Glass, J. L. Balfour et al., “Neighborhoods, aging, often not apparent from objective data (e.g., residents and functional limitations,” in Neighborhoods and Health,I. underreport neighborhood parks because they are not safe Kawachi, L. F. Berkman et al., Eds., pp. 303–334, Oxford University Press, New York, NY, USA, 2003. to use). However, perceptions bundle psychosocial and [6] M. E. Williams, “Identifying the older person likely to require behavioral factors with objective features of the environment long-term care services,” Journal of the American Geriatrics [46]. Studies using perceived measures face a number of Society, vol. 35, no. 8, pp. 761–766, 1987. methodological challenges and bias issues that complicate [7] B. W. Penninx, L. Ferrucci, S. G. Leveille, T. Rantanen, M. their interpretation [47]. Perceived and objective measures Pahor, and J. M. Guralnik, “Lower extremity performance are known to capture different conceptual aspects of many in nondisabled older persons as a predictor of subsequent environmental factors [24]. Only five articles included in hospitalization,” The Journals of Gerontology. Series A, vol. 55, this review assessed perceived as well as objective measures, no. 11, pp. M691–M697, 2000. though only two included comparable variables [29, 32, [8] J. B. Kuriansky, B. J. Gurland, and J. L. Fleiss, “The assessment 34, 37, 38]. More research is needed that allows direct of self care capacity in geriatric psychiatric patients by objec- comparison of the two types of measures and allows eval- tive and subjective methods,” Journal of Clinical Psychology, vol. 32, no. 1, pp. 95–102, 1976. uation of independent and combined effects on mobility. [9] J.M.Guralnik,E.M.Simonsick,L.Ferruccietal., “A short An additional limitation was the use of broad search terms physical performance battery assessing lower extremity func- resulting in a large number of abstracts. The lack of dual tion: association with self-reported disability and prediction review may have resulted in missed articles, but the use of of mortality and nursing home admission,” Journal of Geron- reference lists as an additional review should have at least tology, vol. 49, no. 2, pp. M85–M94, 1994. partially addressed this. [10] D. B. Reuben, A. L. Siu, and S. Kimpau, “The predictive valid- For this field to advance, research must have a strong ity of self-report and performance-based measures of function theoretical framework, identify associations of the built envi- and health,” The Journal of Gerontology,vol. 47, no.4,pp. ronment with incident mobility restrictions, assess how M106–M110, 1992. changes in the built environment affect mobility, and char- [11] L. P. Fried and J. M. Guralnik, “Disability in older adults: evi- acterize subpopulations among which these associations are dence regarding significance, etiology, and risk,” Journal of the strongest, areas that have not been adequately addressed American Geriatrics Society, vol. 45, no. 1, pp. 92–100, 1997. Journal of Aging Research 9 [12] T. A. Glass, “Conjugating the “tenses” of function: discordance [30] P. K. Patterson and N. J. Chapman, “Urban form and older among hypothetical, experimental, and enacted function in residents’ service use, walking, driving, quality of life, and older adults,” The Gerontologist, vol. 38, no. 1, pp. 101–112, neighborhood satisfaction,” American Journal of Health Pro- 1998. motion, vol. 19, no. 1, pp. 45–52, 2004. [13] A. E. Patla and A. Shumway-Cook, “Dimensions of mobility: [31] C. L. Nagel, N. E. Carlson, M. Bosworth, and Y. L. Michael, defining the complexity and difficulty associated with commu- “The relation between neighborhood built environment and nity mobility,” JournalofAging andPhysicalActivity, vol. 7, no. walking activity among older adults,” American Journal of 1, pp. 7–19, 1999. Epidemiology, vol. 168, no. 4, pp. 461–468, 2008. [14] M. Lawton, “Competence, environmental press, and the adap- [32] Y. Michael, T. Beard, D. Choi, S. Farquhar, and N. Carlson, tation of older people,” in Aging and the Environment,M. “Measuring the influence of built neighborhood environ- Lawton, P. Windley, and T. Byerts, Eds., Springer, New York, ments on walking in older adults,” Journal of Aging and NY, USA, 1982. Physical Activity, vol. 14, no. 3, pp. 302–312, 2006. [15] M. P. Lawton, “Environment and other determinants of well- [33] F. Li, K. J. Fisher, R. C. Brownson, and M. Bosworth, being in older people,” The Gerontologist,vol. 23, no.4,pp. “Multilevel modelling of built environment characteristics 349–357, 1983. related to neighbourhood walking activity in older adults,” [16] L. M. Verbrugge and A. M. Jette, “The disablement process,” Journal of Epidemiology and Community Health, vol. 59, no. Social Science and Medicine, vol. 38, no. 1, pp. 1–14, 1994. 7, pp. 558–564, 2005. [17] World Health Organization, International Classification of [34] K. J. Fisher, F. Li, Y. Michael, and M. Cleveland, “Neighbor- Functioning, Disability, and Health: ICF Short Version, vol. iii, hood-level influences on physical activity among older adults: World Health Organization, Geneva, Switzerland, 2001. a multilevel analysis,” JournalofAging andPhysicalActivity, [18] L. D. Frank, P. O. Engelke, and T. L. Schmid, Health and vol. 12, no. 1, pp. 45–63, 2004. Community Design: The Impact of the Built Environment on [35] E. M. Berke, T. D. Koepsell, A. V. Moudon, R. E. Hoskins, and Physical Activity, Island Press, Washington, DC, USA, 2003. E. B. Larson, “Association of the built environment with phys- [19] I. H. Yen, Y. L. Michael, and L. Perdue, “Neighborhood envi- ical activity and obesity in older persons,” American Journal of ronment in studies of health of older adults: a systematic Public Health, vol. 97, no. 3, pp. 486–492, 2007. review,” American Journal of Preventive Medicine, vol. 37, no. [36] D. King, “Neighborhood and individual factors in activity in 5, pp. 455–463, 2009. older adults: results from the neighborhood and senior health [20] P. Clarke and E. R. Nieuwenhuijsen, “Environments for study,” Journal of Aging and Physical Activity,vol. 16, no.2,pp. healthy ageing: a critical review,” Maturitas,vol. 64, no.1,pp. 144–170, 2008. 14–19, 2009. [37] W. A. Satariano, S. L. Ivey, E. Kurtovich et al., “Lower-body [21] T. Sugiyama and C. W. Thompson, “Outdoor environments, function, neighborhoods, and walking in an older popula- activity and the well-being of older people: conceptualising tion,” American Journal of Preventive Medicine, vol. 38, no. 4, environmental support,” Environment and Planning, vol. 39, pp. 419–428, 2010. no. 8, pp. 1943–1960, 2007. [38] K. S. Hall and E. McAuley, “Individual, social environmental [22] A. Renalds, T. H. Smith, and P. J. Hale, “A systematic review of and physical environmental barriers to achieving 10 000 steps built environment and health,” Family and Community Health, per day among older women,” Health Education Research, vol. vol. 33, no. 1, pp. 68–78, 2010. 25, no. 3, pp. 478–488, 2010. [23] S. Macintyre, A. Ellaway, and S. Cummins, “Place effects on [39] P. Clarke and L. K. George, “The role of the built environment health: how can we conceptualise, operationalise and measure in the disablement process,” American Journal of Public Health, them?” Social Science and Medicine, vol. 55, no. 1, pp. 125–139, vol. 95, no. 11, pp. 1933–1939, 2005. [40] J. R. Beard, S. Blaney, M. Cerda et al., “Neighborhood [24] I. Kawachi and L. F. Berkman, Neighborhoods and Health, characteristics and disability in older adults,” The Journals of Oxford University Press, New York, NY, USA, 2003. Gerontology. Series B, vol. 64, no. 2, pp. 252–257, 2009. [25] P. Clarke, J. A. Ailshire, and P. Lantz, “Urban built environ- [41] G. O. Cunningham and Y. L. Michael, “Concepts guiding the ments and trajectories of mobility disability: findings from study of the impact of the built environment on physical a national sample of community-dwelling American adults activity for older adults: a review of the literature,” American (1986–2001),” Social Science and Medicine,vol. 69, no.6,pp. Journal of Health Promotion, vol. 18, no. 6, pp. 435–443, 2004. 964–970, 2009. [42] S. Handy, X. Y. Cao, and P. L. Mokhtarian, “Self-selection in [26] S. C. Brown, C. A. Mason, T. Perrino et al., “Built environment the relationship between the built environment and walking: and physical functioning in hispanic elders: the role of ‘eyes on empirical evidence from Northern California,” Journal of the the street’,” Environmental Health Perspectives, vol. 116, no. 10, American Planning Association, vol. 72, no. 1, pp. 55–74, 2006. pp. 1300–1307, 2008. [43] P. S. Baker, E. V. Bodner, and R. M. Allman, “Measuring life- [27] I. M. Lee, R. Ewing, and H. D. Sesso, “The built environment space mobility in community-dwelling older adults,” Journal and physical activity levels. The Harvard alumni health study,” of the American Geriatrics Society, vol. 51, no. 11, pp. 1610– American Journal of Preventive Medicine,vol. 37, no.4,pp. 1614, 2003. 293–298, 2009. [28] Y. L. Michael, L. A. Perdue, E. S. Orwoll, M. L. Stefanick, and [44] C. Peel,P.S.Baker,D.L.Roth, C. J. Brown, E. V. Bodner, andR. M. Allman, “Assessing mobility in older adults: the UAB sudy L. M. Marshall, “Physical activity resources and changes in walking in a cohort of older men,” American Journal of Public of aging life-space assessment,” Physical Therapy, vol. 85, no. 10, pp. 1008–1019, 2005. Health, vol. 100, no. 4, pp. 654–660, 2010. [29] L. F. Gomez, D. C. Parra, D. Buchner et al., “Built environment [45] S. C. Webber and M. M. Porter, “Monitoring mobility in attributes and walking patterns among the elderly population older adults using global positioning system (GPS) watches in Bogota,” American Journal of Preventive Medicine, vol. 38, and accelerometers: a feasibility study,” Journal of Aging and no. 6, pp. 592–599, 2010. Physical Activity, vol. 17, no. 4, pp. 455–467, 2009. 10 Journal of Aging Research [46] A. Bowling and M. Stafford, “How do objective and subjective assessments of neighbourhood influence social and physical functioning in older age? Findings from a British survey of ageing,” Social Science and Medicine, vol. 64, no. 12, pp. 2533– 2549, 2007. [47] S. W. Raudenbush and R. J. Sampson, “Ecometrics: toward a science of assessing ecological settings, with application to the systematic social observation of neighborhoods,” Sociological Methodology, vol. 29, no. 1, pp. 1–41, 1999. [48] K. E. Pickett and M. Pearl, “Multilevel analyses of neighbour- hood socioeconomic context and health outcomes: a critical review,” Journal of Epidemiology and Community Health, vol. 55, no. 2, pp. 111–122, 2001. [49] J. B. McKinlay, “The promotion of health through planned sociopolitical change: challenges for research and policy,” Social Science and Medicine, vol. 36, no. 2, pp. 109–117, 1993. [50] G. Rose, “Sick individuals and sick populations,” International Journal of Epidemiology, vol. 14, no. 1, pp. 32–38, 1985. [51] A. E. Scharlach, “Creating aging-friendly communities,” Gen- erations, vol. 33, no. 2, pp. 5–11, 2009. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Aging Research Hindawi Publishing Corporation

The Urban Built Environment and Mobility in Older Adults: A Comprehensive Review

Loading next page...
 
/lp/hindawi-publishing-corporation/the-urban-built-environment-and-mobility-in-older-adults-a-uT2YSxoy9E

References (56)

Publisher
Hindawi Publishing Corporation
Copyright
Copyright © 2011 Andrea L. Rosso et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ISSN
2090-2204
eISSN
2090-2212
DOI
10.4061/2011/816106
Publisher site
See Article on Publisher Site

Abstract

SAGE-Hindawi Access to Research Journal of Aging Research Volume 2011, Article ID 816106, 10 pages doi:10.4061/2011/816106 Review Article The Urban Built Environment and Mobility in Older Adults: AComprehensive Review Andrea L. Rosso, Amy H. Auchincloss, and Yvonne L. Michael Department of Epidemiology and Biostatistics, Drexel University School of Public Health, 1505 Race Street, Mail Stop 1033, Bellet 6th Floor, Philadelphia, PA 19102, USA Correspondence should be addressed to Andrea L. Rosso, alr44@drexel.edu Received 16 December 2010; Accepted 3 May 2011 Academic Editor: Thomas R. Prohaska Copyright © 2011 Andrea L. Rosso et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Mobility restrictions in older adults are common and increase the likelihood of negative health outcomes and premature mortality. The effect of built environment on mobility in older populations, among whom environmental effects may be strongest, is the focus of a growing body of the literature. We reviewed recent research (1990–2010) that examined associations of objective measures of the built environment with mobility and disability in adults aged 60 years or older. Seventeen empirical articles were identified. The existing literature suggests that mobility is associated with higher street connectivity leading to shorter pedestrian distances, street and traffic conditions such as safety measures, and proximity to destinations such as retail establishments, parks, and green spaces. Existing research is limited by differences in exposure and outcome assessments and use of cross-sectional study designs. This research could lead to policy interventions that allow older adults to live more healthy and active lives in their communities. 1. Introduction enacted function—what an individual does do [12]. In this way, assessments of an individual’s walking behavior Mobility limitations are defined by impairment or depen- represent an enacted form of mobility while questions that dence in movement and affect between one third and one assess an individual’s perception of their ability represent half of adults aged 65 or older [1]. Mobility limitations can functional capacity. Both may be relevant measures of affect an individual’s health through a number of pathways. mobility. Lack of physical activity in older individuals can lead to Mobility restrictions are not typically the result of a loss of muscle mass (sarcopenia), loss of bone density single cause, but arise from an interaction of risk factors (osteoporosis), and an increase in fat mass (obesity) [2, in various domains, both individual and environmental 3]. Isolation and loss of social ties resulting from reduced [1]. Traditionally, disability research had been based on mobility can lead to depression and other adverse mental the medical model in which the focus is on the individual health outcomes [4]. A lack of access to resources such and pathology [13]. More recently, following on the work as fresh foods and medical care which can result from of Lawton [14, 15], Verbrugge and Jette [16], and the limited mobility can also have negative impacts on health [5]. World Health Organization’s International Classification of Individuals with mobility limitations are also at higher risk Functioning, Disability, and Health (ICF) [17], disability of health service utilization [6–8] and institutionalization models have focused on the interaction of the individual [6, 9, 10]. Ultimately, further frailty and disability and with their environment. Lawton stressed the importance an increased risk of premature mortality can result from of the environment in determining the well-being of older restricted mobility [1, 11]. adults where an individual’s competence to deal with their Methods of assessing mobility limitations vary [1]. In environment combines with the stresses, or press, that the assessment of mobility, it is important to distinguish between environment places on that individual [14]. Thus, Lawton’s capacity to function—what an individual could do—and model adds the possibility that mobility may be enhanced 2 Journal of Aging Research through environmental buoys as compared to the medical Use of self-reported measures of the environment is model that assumes decline [5]. Both the ICF and Verbrugge common in the existing literature but relies on participant’s perception of problems rather than actual presence of stress the importance and bidirectionality of environmental as well as personal factors on individual health [16, 17]. barriers. Evidence consistently shows differences between objective and perceived measures of the local environment Environmental characteristics are hypothesized to limit or [19, 24]. The two measurement types are likely capturing dif- promote an individual’s ability to complete purposeful ferent constructs both of which are important in determining actions and fulfill role expectations, affecting physical func- mobility of older adults. We focus on objective measures tioning and disability (see Figure 1). here in an attempt to summarize the direct effects of built Olderadults maybemorevulnerabletoinfluenceof environment factors as these can be ideal targets for public their residential environment as they tend to travel outside policy interventions. their own neighborhoods less often than do younger adults The goal of this paper is to summarize the recent and children who travel for work and school and tend published literature on objective measures of the built to have a longer duration of exposure to neighborhood environment and mobility or disability in older adults and influences than younger individuals [5]. Declining physical provide a critical analysis of the limitations. and mental health, shrinking social networks, loss of social support, and increased fragility may also reduce the ability of older individuals to cope with environmental demands 2. Methods [5, 19, 20]. Therefore, neighborhood environment likely has a greater impact on the elderly than on those in other age Searches of Medline and Web of Science were conducted for groups and evidence suggests that supportive environments English-only articles published between 1 January, 1990 and improve quality of life in older adults [21]. Lawton proposed 7 December, 2010 with the following keyword search terms: several dimensions of environment that are important neighborhood, built environment, or physical environment and elderly, older adults, aging, mobility, disability, walking, for older adults: personal environment (family, friends), or physical function. Additional articles were identified suprapersonal environment (i.e., neighborhood racial or age through consultation with experts and review of reference composition), social environment (norms or values related lists of included articles. Inclusion criteria were (1) the to society or culture), and physical environment (e.g., built study population consisted of community-dwelling adults environment) [14]. The built environment is defined as the aged 60 years or older or if no range was provided, the human-made or human-altered space in which individuals average age was ≥65 years, (2) built environment was live out their daily lives [22] and is the focus of this paper. objectively measured either through use of administrative Much of the existing research regarding neighborhoods datasets or research rater assessments, (3) outcomes included and health has been conducted in younger or middle-aged measures of mobility or disability and physical functioning adults and has focused on aspects of the environment other as described in Verbrugge’s disablement model [16]. Articles than the physical or built environment [19, 20, 23]. The were excluded if they were a review or commentary or if they built environment’s effect on health has been conceptualized provided qualitative data only. into three domains: transportation systems which include street networks and transit systems, land use patterns which includes density and land-use mix, and urban design 3. Results which includes safety, attractiveness, and site design [18]. Transportation systems are defined as the network of physical We reviewed 31,596 abstracts for relevancy to this paper. infrastructure, such as its street network, transit systems, and Of these, 28 articles were reviewed for inclusion criteria, trails (e.g., for jogging or biking,). Transportation systems with seventeen articles meeting our criteria. Details of influence how easy it is to travel through a neighborhood these studies are provided in Table 1. Four studies were and get to places a person wants to go. Land use patterns longitudinal [25–28]; the remainder assessed cross-sectional reflect where and how residential, commercial, and industrial associations. One study used nationally representative data uses are distributed in a neighborhood. Density of land from the USA [25] and one was conducted outside the USA use represents an increased compactness of neighborhoods [29]. Seven of the studies (41%) were conducted in the with easier access to pedestrian destinations. Urban design Pacific Northwest [28, 30–35]. Enacted function, or walking characteristics—such as number and width of trafficlanes, in some form, was the most commonly assessed outcome, size and extensiveness of sidewalks, traffic calming devices— though there was little overlap in the way in which walking influence safety and attractiveness and ultimately decisions was assessed. Walking has been measured as specifically for about whether or not to walk. Pleasant pedestrian environ- exercise [35], for utilitarian purposes [30, 36], by frequency ments that promote feelings of belonging to a neighborhood of neighborhood walking on a Likert scale [32–34], by and trust in ones neighbors can be created through positive whether individuals met physical activity recommendations urbandesign[18]. In contrast, evidence of decay, such as for walking (>150 hours/week) [27, 29, 37], and by other vandalism and poorly maintained vacant lots, can reduce measures of walking frequency [3, 28, 31]. One study used mobility by creating feelings of discomfort in one’s neigh- accelerometers to directly measure the number of steps borhood. All three of these domains can potentially impact taken by participants in a day [38]. There were also a wide mobility in the elderly (see Figure 1). range of definitions for neighborhood, including specified Journal of Aging Research 3 Built Land use Transportation Urban design environment systems patterns Functional Pathology Impairments limitations Disability (including mobility) Individual factors Built environment Transportation systems: street network, transit systems Land use patterns: density, land-use mix Urban design: safety, attractiveness, site design Disablement pathway Pathology: disease or injury Impairments: dysfunction in body systems Functional limitations: restrictions in purposeful actions including mobility and enacted forms of walking Disability: difficulty performing expected activities and roles Individual factors: gender, age, health conditions, financial resources, etc. Figure 1: The role of the built environment in the disablement process (adapted from Verbrugge and Jette, 1994 [16] and Frank et al., 2003 [18]). distances from an individual’s home (i.e., quarter-mile transit, was not associated with walking in two studies radius), census tracts, and other administratively defined [29, 31]. Street connectivity, indicating shorter blocks with neighborhoods. Subgroup analyses were completed in only 5 more intersections and resulting in easier pedestrian links studies, including gender [35], lower body functional status between two points, have been studied in relation to walking [37, 39], age [25], and neighborhood socioeconomic status in older adults with mixed results. Nagel and colleagues and [28]. Fewer than half of the studies explicitly stated the Satariano and colleagues found no association [31, 37], Li theoretical framework or causal model that guided their and colleagues found a positive association [33], and Gomez research in the article [26, 28, 30, 34, 37–39]. Effect sizes and colleagues found an unexpected negative association tended to be small: approximately three-quarters of the [29]. Differences in study site, neighborhood definitions, statistically significant estimates had relative risks or odds and operationalization of walking likely accounted for some ratios below 2.0 (range was 1.08 to 4.12). differences in results for street connectivity. Neighborhoods were specified differently in the four studies: those studies finding no association, Nagel et al. [31] and Satariano et al. 3.1. Transportation Systems. Traffic-related street charac- [37], used a specified distance from homes, Li et al. [33] teristics have been assessed in relation to mobility, with used city-defined neighborhoods, and Gomez et al. [29] high-traffic volume positively associated with walking [31]. used neighborhoods defined by socioeconomic status. Two However, presence of through routes, representing high- discordant studies were conducted in the same city (Nagel traffic volume, was not associated with disability [40]. A high et al. [31]and Li et al.[33]) and another two discordant percentage of car commuters, indicating a greater reliance on studies both assessed walking as meeting physical activity driving rather than walking for transportation, was positively recommendations (Satariano et al. [37] and Gomez et al. associated with increased walking difficulty among those [29]). aged 75 and older, but not among younger age groups [25]. Living within a specified area of Bogota, ´ Columbia in which streets are closed to vehicular traffic on Sundays and holidays, 3.2. Land Use Patterns. Housing density was associated with creating a pedestrian corridor, was positively associated with greater levels of walking [33] and with less disability among walking among older residents [29]. Proximity to walking those with lower body functional limitations [39]. However, paths and trails was associated with amount of daily walking population density was not associated with increased walking [38] but not with frequency of neighborhood walking [32]. difficulty over 15 years [25]. Mix of land use, representing Finally, presence of nearby transit stops, providing access proximity to a variety of destinations such as places of em- to areas outside the immediate neighborhood via public ployment and retail establishments, has been assessed in 4 Journal of Aging Research Table 1: Details of reviewed articles of built environment characteristics and mobility in those aged 60 years and older. Associations Neighborhood Age range or Built environment Expected Unexpected Reference Sample Size Location definition Outcomes Null mean (SD) measures direction direction (n units) Census tracts Beard et al., 2009 [40] 937,857 New York, New York 65+ Mixed land use Disability X (2,138) Neighborhood Disability X decay Through routes Disability X Poor street Disability X characteristics Walkability index 100, 500, or including residential Berke et al., 2007 [35] 1967 Seattle, Washington 65–97 1000 meters Walking X and commercial from homes density Physical Mean = 78.5 Participant’s Front entrance functioning after X Brown et al., 2008 [26] 273 Miami, Florida (NR) block characteristics 24 months Mean = 73.55 Census tracts Housing density Disability X Clarke & George, 2005 [39] 4154 North Carolina (6.72) (95) Land use diversity X Results for: Increase in walking Census tracts Clarke et al., 2009 [25] 1821 USA 65–74 and Population density difficulty over 15 X (1821) 75+ years Non-automobile commuters 64–94; Mean City defined Fisher et al., 2004 [34] 582 Portland, Oregon = 73.99 neighborhoods Parks Walking X (6.25) (56) Walkability index including land use 1kilometer Frank et al., 2010 [3] 1970 Atlanta, Georgia 65+ mix, residential Walking X from homes density and street connectivity 60–98; Researcher Lives in weekend Gomez et al., 2010 [29] 1886 Bogota, ´ Columbia Mean= 70.7 defined by SES pedestrian-only Walking X (7.7) (50) corridor Transit stops X Parks X Connectivity X Mean = 69.8 1kilometer Paths Walking X Hall & McAuley, 2010 [38] 128 Illinois (5.89) from homes Parks X Journal of Aging Research 5 Table 1: Continued. Associations Neighborhood Age range or Built environment Expected Unexpected Reference Sample Size Location definition Outcomes Null mean (SD) measures direction direction (n units) Recreation areas X Exercise/gym facilities Schools X City defined Mean = 74.2 Sidewalk neighborhoods Walking X King, 2008 [36] 190 Denver, Colorado (5.8) functionality (8) Safety from traffic X Aesthetics X Destinations X Walking—cross- Mean=70 County (448) Sprawl sectional X Lee et al., 2009 [27] 4997 USA (NR) analysis Increase in walking over 5 years City defined Mean = 74 Residential Li et al., 2005 [33] 582 Portland, Oregon neighborhoods Walking X (6.3) households (56) Places of employment Street intersections X Green space and recreational facilities City defined Mean = 75.1 Michael et al., 2006 [32] 105 Portland, Oregon neighborhoods Shopping mall Walking X (6.3) (10) Trails X Sidewalk presence X Sidewalk condition X Graffiti/vandalism X 1/8, 1/4, and 1/2 Increase in walking Michael et al., 2010 [28] 422 Portland, Oregon Median = 74 mile from Parks over 3–6 year X homes follow-up Trails X Recreational facilities Mean = 74.5 1/4 or 1/2 mile Automobile traffic Nagel et al., 2008 [31] 546 Portland, Oregon Walking X (6.3) from homes volume Sidewalk coverage X 6 Journal of Aging Research Table 1: Continued. Associations Neighborhood Age range or Built environment Expected Unexpected definition Outcomes Null Reference Sample Size Location mean (SD) measures direction direction (n units) Intersection frequency Public transportation X access Retail establishments Park/green space X New Urbanism Index including mix Patterson & Chapman, 2004 [30] 133 Portland, Oregon 70–92 Census tract (6) Walking X use, connectivity and aesthetics Within 400 Common Satariano et al., 2010 [37] 884 4 USA locations 65+ Walking X meters of homes destinations Street connectivity X Commercial/mixed use neighborhood From administrative databases unless otherwise indicated. From fully adjusted models when multiple results provided. From rater assessments. Among those living in same residence for ≥2 years, positive association was found only among women. Positive association was found only among those with lower body impairments. Positive association was found only among those aged 75 and older. Positive association was found only among those in high socioeconomic neighborhoods. Locations include Alameda County, CA; Allegheny County, PA; Cook County, IL; and Wake and Durham Counties, NC. NR: not reported. Journal of Aging Research 7 several studies with inconsistent results. More mixed land automobiles for transportation. Urban sprawl measured by use was negatively associated with walking in one study [37], census data was negatively associated with walking in cross- negatively associated with disability among those with lower sectional analysis, but no association was found between body limitations in another [25], and unassociated with movement to an area classified as more or less sprawling and disability in a third [40]. change in walking behavior [27]. Neighborhood walkability Proximity to particular destinations has been widely scores have included land use mix, residential density, street assessed as a promoter of mobility among older adults. connectivity, park and trail presence, and vehicular traffic Presence of destinations may increase mobility by providing information. Frank and colleagues demonstrated a positive locations for recreational walking or by providing access to association between their walkability score and walking needed services such as grocery stores. No associations have [3], whereas Berke and colleagues found a positive asso- been found between walking and presence of recreational ciation only among women [35]. Patterson and Chapman facilities [28, 38], gyms [38], or schools [38]. In contrast, developed a scale that combines elements of urban sprawl shopping malls and overall retail destinations have been and walkability and found it was positively associated with associated with walking [31, 32]. More general measures walking among older adults in their study [30]. Another of destinations have been used, including a measure of study reported negative street characteristics, defined as low total places of employment which was positively associated density of intersections, few shade trees and few transit stops, with walking [33] and two separate measures of select were associated with greater disability [40]. destinations, including places such as retail businesses and parks, neither of which was associated with walking [36, 37]. 4. Conclusions 3.3. Urban Design. Front entrance characteristics that pro- The evidence provides empirical support for an association mote social interactions, such as presence of a stoop and between aspects of the built environment and mobility in a shallow housing setback, were positively associated with older adults. This paper suggests that built environment physical functioning among older adults in a Hispanic characteristics from three domains (transportation systems, neighborhood [26]. Neighborhood decay, represented by land use patterns, and urban design) can impact both presence of graffiti or vandalism, was not associated with functional limitations and disability in positive and negative disability [40]. Graffiti or vandalism was associated with directions. However, it is still unclear if these associations less walking in one study [36] but not associated in an- represent direct influences on the disablement process. other [32]. Differences in results for the two walking studies The most promising evidence points to high density of cannot be attributed to size of the studies or to assess- intersections, street and traffic conditions, and proximity ment of neighborhood as these were similar for both to select destinations and green space as the most likely studies. However, the study finding no association evaluated factors to impact mobility, though results have been incon- walking as frequency of any neighborhood walking and the sistent. These inconsistencies are likely due to differences in one reporting a positive association measured walking for methodology. There are many differences between studies errands only. Neither presence nor condition of sidewalks regarding neighborhood definition, exposure measurements, was associated with walking in several studies [31, 32, 36] and outcome assessment. but presence of safety measures for pedestrians against traffic Theoretical and methodological limitations are present was associated with walking [36]. Presence of parks has been in much of the existing literature on this topic. A num- positively associated with walking in two studies [33, 34], ber of papers lacked an explicit theoretical framework to but no association was found in three others [29, 31, 38]. guide determination of which neighborhood factors may These inconsistencies may be a result of different localities, impact mobility, at what spatial resolution effects should differences in neighborhood definitions, or differences in be assessed, and which individual and neighborhood level outcomes assessments as these all differed between those with factors should be considered as confounders or mediators positive findings and those with findings of no association. [19, 23, 41]. A majority of the existing literature is cross- Michael and colleagues demonstrated a positive association sectional, making causal inferences impossible [19, 20, 22, between proximity to parks or paths and increases in walking 24]. It is unknown whether individuals adapt their mobility over a 3–6-year period among men living in neighborhoods based on environmental presses and buoys or whether they classified as having high socioeconomic status but not among choose neighborhoods with fewer environmental demands those living in low socioeconomic status neighborhoods as their potential mobility decreases. However, there is some [28]. evidence that an effect of built environment on walking persists even after accounting for selection factors [42]. 3.4. Composite Scores. For some study questions, a theoreti- It is unlikely that built environment characteristics affect cal framework was used to guide the development of a built all neighborhood residents in the same manner [19, 24]. environment summary score. If the items in the summary Assessing subpopulations among older adults may prove score are similarly correlated with mobility, it may provide a important as the socially disadvantaged among them— more robust exposure than a single measure. Urban sprawl women, minorities, and those with low income—may be represents density of land use with more sprawling areas more vulnerable to environmental factors and have a higher often having poorer accessibility and greater reliance on propensity to live in disadvantaged neighborhoods [5, 20]. 8 Journal of Aging Research In addition, results should be replicated in different localities in previous research. In general, effect sizes of associations as the existing research has been limited in its geographic between built environment characteristics and functioning scope and it is unclear if differences may be due to unique in older adults are small to moderate. However, a large per- characteristics of a locality. Greater use of nationally repre- centage of the population is exposed to these conditions, sentative data may help to confirm results and assess effect indicating that the potential public health impact of policy modification by location, although these studies may suffer interventions could be great [48]. The advantage of popula- from less detailed measures of the built environment. tion level interventions over those that target only high-risk Finally, this research field would benefit from use of individuals has been demonstrated [49, 50]. In general, older broader measures of enacted mobility. This paper has iden- adults wish to age in place, remaining in their homes rather tified walking measures as the primary measure of mobility; than moving to potentially more accommodating locations however, general mobility may be more important than [51]. In order to facilitate aging in place and maintaining walking, specifically. Use of assistive devices, public trans- quality of life as people age, it is important to understand portation, and personal automobiles allow for increased the role of the built environment on mobility limitations and mobility and access to services such as healthcare and health- disability while addressing the limitations of the current body y foods [1]. General mobility assessments are available, of evidence. such as the University of Alabama Birmingham Life-Space Assessment [43, 44]. Life-space is defined as the spatial References area traveled by an individual in their daily life over a specified period of time. The Life-Space Assessment assesses [1] S. C. Webber, M. M. Porter, and V. H. Menec, “Mobility in extent of movement in the past month, how frequently older adults: a comprehensive framework,” The Gerontologist, that movement occurred, and whether assistance was used vol. 50, no. 4, pp. 443–450, 2010. [43]. New technologies are also allowing objective measures [2] L. DiPietro, “Physical activity in aging: changes in patterns of mobility through use of individual global positioning and their relationship to health and function,” The Journals of system (GPS) monitors [45]. GPS monitors do not rely on Gerontology. Series A, vol. 56, no. 2, pp. 13–22, 2001. individual recall, allow assessment of individual trips into [3] L. Frank, J. Kerr, D. Rosenberg, and A. King, “Healthy aging and where you live: community design relationships with the community, and can provide information on specific physical activity and body weight in older Americans,” Journal location and speed of movement [45]. of Physical Activity and Health, vol. 7, supplement 1, pp. S82– The current review is limited in that it addresses only S90, 2010. objective measures of the built environment. While objective [4] P. Lampinen and E. Heikkinen, “Reduced mobility and phys- characteristics are more relevant to policy interventions [19], ical activity as predictors of depressive symptoms among perceived measures capture important information about an community-dwelling older adults: an eight-year follow-up individual’s relationship with their environment. Perceived study,” Aging Clinical and Experimental Research, vol. 15, no. environmental measures can more easily assess quality and 3, pp. 205–211, 2003. access to resources within the built environment that are [5] T. A. Glass, J. L. Balfour et al., “Neighborhoods, aging, often not apparent from objective data (e.g., residents and functional limitations,” in Neighborhoods and Health,I. underreport neighborhood parks because they are not safe Kawachi, L. F. Berkman et al., Eds., pp. 303–334, Oxford University Press, New York, NY, USA, 2003. to use). However, perceptions bundle psychosocial and [6] M. E. Williams, “Identifying the older person likely to require behavioral factors with objective features of the environment long-term care services,” Journal of the American Geriatrics [46]. Studies using perceived measures face a number of Society, vol. 35, no. 8, pp. 761–766, 1987. methodological challenges and bias issues that complicate [7] B. W. Penninx, L. Ferrucci, S. G. Leveille, T. Rantanen, M. their interpretation [47]. Perceived and objective measures Pahor, and J. M. Guralnik, “Lower extremity performance are known to capture different conceptual aspects of many in nondisabled older persons as a predictor of subsequent environmental factors [24]. Only five articles included in hospitalization,” The Journals of Gerontology. Series A, vol. 55, this review assessed perceived as well as objective measures, no. 11, pp. M691–M697, 2000. though only two included comparable variables [29, 32, [8] J. B. Kuriansky, B. J. Gurland, and J. L. Fleiss, “The assessment 34, 37, 38]. More research is needed that allows direct of self care capacity in geriatric psychiatric patients by objec- comparison of the two types of measures and allows eval- tive and subjective methods,” Journal of Clinical Psychology, vol. 32, no. 1, pp. 95–102, 1976. uation of independent and combined effects on mobility. [9] J.M.Guralnik,E.M.Simonsick,L.Ferruccietal., “A short An additional limitation was the use of broad search terms physical performance battery assessing lower extremity func- resulting in a large number of abstracts. The lack of dual tion: association with self-reported disability and prediction review may have resulted in missed articles, but the use of of mortality and nursing home admission,” Journal of Geron- reference lists as an additional review should have at least tology, vol. 49, no. 2, pp. M85–M94, 1994. partially addressed this. [10] D. B. Reuben, A. L. Siu, and S. Kimpau, “The predictive valid- For this field to advance, research must have a strong ity of self-report and performance-based measures of function theoretical framework, identify associations of the built envi- and health,” The Journal of Gerontology,vol. 47, no.4,pp. ronment with incident mobility restrictions, assess how M106–M110, 1992. changes in the built environment affect mobility, and char- [11] L. P. Fried and J. M. Guralnik, “Disability in older adults: evi- acterize subpopulations among which these associations are dence regarding significance, etiology, and risk,” Journal of the strongest, areas that have not been adequately addressed American Geriatrics Society, vol. 45, no. 1, pp. 92–100, 1997. Journal of Aging Research 9 [12] T. A. Glass, “Conjugating the “tenses” of function: discordance [30] P. K. Patterson and N. J. Chapman, “Urban form and older among hypothetical, experimental, and enacted function in residents’ service use, walking, driving, quality of life, and older adults,” The Gerontologist, vol. 38, no. 1, pp. 101–112, neighborhood satisfaction,” American Journal of Health Pro- 1998. motion, vol. 19, no. 1, pp. 45–52, 2004. [13] A. E. Patla and A. Shumway-Cook, “Dimensions of mobility: [31] C. L. Nagel, N. E. Carlson, M. Bosworth, and Y. L. Michael, defining the complexity and difficulty associated with commu- “The relation between neighborhood built environment and nity mobility,” JournalofAging andPhysicalActivity, vol. 7, no. walking activity among older adults,” American Journal of 1, pp. 7–19, 1999. Epidemiology, vol. 168, no. 4, pp. 461–468, 2008. [14] M. Lawton, “Competence, environmental press, and the adap- [32] Y. Michael, T. Beard, D. Choi, S. Farquhar, and N. Carlson, tation of older people,” in Aging and the Environment,M. “Measuring the influence of built neighborhood environ- Lawton, P. Windley, and T. Byerts, Eds., Springer, New York, ments on walking in older adults,” Journal of Aging and NY, USA, 1982. Physical Activity, vol. 14, no. 3, pp. 302–312, 2006. [15] M. P. Lawton, “Environment and other determinants of well- [33] F. Li, K. J. Fisher, R. C. Brownson, and M. Bosworth, being in older people,” The Gerontologist,vol. 23, no.4,pp. “Multilevel modelling of built environment characteristics 349–357, 1983. related to neighbourhood walking activity in older adults,” [16] L. M. Verbrugge and A. M. Jette, “The disablement process,” Journal of Epidemiology and Community Health, vol. 59, no. Social Science and Medicine, vol. 38, no. 1, pp. 1–14, 1994. 7, pp. 558–564, 2005. [17] World Health Organization, International Classification of [34] K. J. Fisher, F. Li, Y. Michael, and M. Cleveland, “Neighbor- Functioning, Disability, and Health: ICF Short Version, vol. iii, hood-level influences on physical activity among older adults: World Health Organization, Geneva, Switzerland, 2001. a multilevel analysis,” JournalofAging andPhysicalActivity, [18] L. D. Frank, P. O. Engelke, and T. L. Schmid, Health and vol. 12, no. 1, pp. 45–63, 2004. Community Design: The Impact of the Built Environment on [35] E. M. Berke, T. D. Koepsell, A. V. Moudon, R. E. Hoskins, and Physical Activity, Island Press, Washington, DC, USA, 2003. E. B. Larson, “Association of the built environment with phys- [19] I. H. Yen, Y. L. Michael, and L. Perdue, “Neighborhood envi- ical activity and obesity in older persons,” American Journal of ronment in studies of health of older adults: a systematic Public Health, vol. 97, no. 3, pp. 486–492, 2007. review,” American Journal of Preventive Medicine, vol. 37, no. [36] D. King, “Neighborhood and individual factors in activity in 5, pp. 455–463, 2009. older adults: results from the neighborhood and senior health [20] P. Clarke and E. R. Nieuwenhuijsen, “Environments for study,” Journal of Aging and Physical Activity,vol. 16, no.2,pp. healthy ageing: a critical review,” Maturitas,vol. 64, no.1,pp. 144–170, 2008. 14–19, 2009. [37] W. A. Satariano, S. L. Ivey, E. Kurtovich et al., “Lower-body [21] T. Sugiyama and C. W. Thompson, “Outdoor environments, function, neighborhoods, and walking in an older popula- activity and the well-being of older people: conceptualising tion,” American Journal of Preventive Medicine, vol. 38, no. 4, environmental support,” Environment and Planning, vol. 39, pp. 419–428, 2010. no. 8, pp. 1943–1960, 2007. [38] K. S. Hall and E. McAuley, “Individual, social environmental [22] A. Renalds, T. H. Smith, and P. J. Hale, “A systematic review of and physical environmental barriers to achieving 10 000 steps built environment and health,” Family and Community Health, per day among older women,” Health Education Research, vol. vol. 33, no. 1, pp. 68–78, 2010. 25, no. 3, pp. 478–488, 2010. [23] S. Macintyre, A. Ellaway, and S. Cummins, “Place effects on [39] P. Clarke and L. K. George, “The role of the built environment health: how can we conceptualise, operationalise and measure in the disablement process,” American Journal of Public Health, them?” Social Science and Medicine, vol. 55, no. 1, pp. 125–139, vol. 95, no. 11, pp. 1933–1939, 2005. [40] J. R. Beard, S. Blaney, M. Cerda et al., “Neighborhood [24] I. Kawachi and L. F. Berkman, Neighborhoods and Health, characteristics and disability in older adults,” The Journals of Oxford University Press, New York, NY, USA, 2003. Gerontology. Series B, vol. 64, no. 2, pp. 252–257, 2009. [25] P. Clarke, J. A. Ailshire, and P. Lantz, “Urban built environ- [41] G. O. Cunningham and Y. L. Michael, “Concepts guiding the ments and trajectories of mobility disability: findings from study of the impact of the built environment on physical a national sample of community-dwelling American adults activity for older adults: a review of the literature,” American (1986–2001),” Social Science and Medicine,vol. 69, no.6,pp. Journal of Health Promotion, vol. 18, no. 6, pp. 435–443, 2004. 964–970, 2009. [42] S. Handy, X. Y. Cao, and P. L. Mokhtarian, “Self-selection in [26] S. C. Brown, C. A. Mason, T. Perrino et al., “Built environment the relationship between the built environment and walking: and physical functioning in hispanic elders: the role of ‘eyes on empirical evidence from Northern California,” Journal of the the street’,” Environmental Health Perspectives, vol. 116, no. 10, American Planning Association, vol. 72, no. 1, pp. 55–74, 2006. pp. 1300–1307, 2008. [43] P. S. Baker, E. V. Bodner, and R. M. Allman, “Measuring life- [27] I. M. Lee, R. Ewing, and H. D. Sesso, “The built environment space mobility in community-dwelling older adults,” Journal and physical activity levels. The Harvard alumni health study,” of the American Geriatrics Society, vol. 51, no. 11, pp. 1610– American Journal of Preventive Medicine,vol. 37, no.4,pp. 1614, 2003. 293–298, 2009. [28] Y. L. Michael, L. A. Perdue, E. S. Orwoll, M. L. Stefanick, and [44] C. Peel,P.S.Baker,D.L.Roth, C. J. Brown, E. V. Bodner, andR. M. Allman, “Assessing mobility in older adults: the UAB sudy L. M. Marshall, “Physical activity resources and changes in walking in a cohort of older men,” American Journal of Public of aging life-space assessment,” Physical Therapy, vol. 85, no. 10, pp. 1008–1019, 2005. Health, vol. 100, no. 4, pp. 654–660, 2010. [29] L. F. Gomez, D. C. Parra, D. Buchner et al., “Built environment [45] S. C. Webber and M. M. Porter, “Monitoring mobility in attributes and walking patterns among the elderly population older adults using global positioning system (GPS) watches in Bogota,” American Journal of Preventive Medicine, vol. 38, and accelerometers: a feasibility study,” Journal of Aging and no. 6, pp. 592–599, 2010. Physical Activity, vol. 17, no. 4, pp. 455–467, 2009. 10 Journal of Aging Research [46] A. Bowling and M. Stafford, “How do objective and subjective assessments of neighbourhood influence social and physical functioning in older age? Findings from a British survey of ageing,” Social Science and Medicine, vol. 64, no. 12, pp. 2533– 2549, 2007. [47] S. W. Raudenbush and R. J. Sampson, “Ecometrics: toward a science of assessing ecological settings, with application to the systematic social observation of neighborhoods,” Sociological Methodology, vol. 29, no. 1, pp. 1–41, 1999. [48] K. E. Pickett and M. Pearl, “Multilevel analyses of neighbour- hood socioeconomic context and health outcomes: a critical review,” Journal of Epidemiology and Community Health, vol. 55, no. 2, pp. 111–122, 2001. [49] J. B. McKinlay, “The promotion of health through planned sociopolitical change: challenges for research and policy,” Social Science and Medicine, vol. 36, no. 2, pp. 109–117, 1993. [50] G. Rose, “Sick individuals and sick populations,” International Journal of Epidemiology, vol. 14, no. 1, pp. 32–38, 1985. [51] A. E. Scharlach, “Creating aging-friendly communities,” Gen- erations, vol. 33, no. 2, pp. 5–11, 2009. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014

Journal

Journal of Aging ResearchHindawi Publishing Corporation

Published: Jun 30, 2011

There are no references for this article.