Neighborhood Social Cohesion, Physical Disorder, and Daily Activity Limitations Among Community-Dwelling Older Adults

Abstract

Introduction: Although extensive factors have been examined for limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), it remains unclear as to the impacts of neighborhood-level factors on ADL and IADL limitations. Thus, we aim to examine whether neighborhood characteristics are predictive of limitations in ADL and IADL. Methods: A total of 7,407 participants were selected from the National Health and Aging Trend Study. We used data from round 1 (2011) to round 8 (2018). Neighborhood characteristics were measured as social cohesion and physical disorder. Daily activity limitations were counted based on the domains of ADL and IADL. Mixed-effects negative binomial regression analyses were performed to estimate the effects of neighborhood features on ADL and IADL limitations. Results: Better neighborhood social cohesion significantly predicted less limitations in ADL (incidence rate ratio [IRR] = 0.98, 95% confidence interval [CI] = 0.96 - 0.99) and IADL (IRR=0.96, 95% CI = 0.95 - 0.98). More physical disorder predicted more IADL limitations (IRR=1.04, 95% CI = 1.01 - 1.06), but was not associated with ADL limitations. Conclusion: Neighborhood social cohesion is essential in enabling older adults to perform both basic self-care activities and more complex tasks, while neighborhood physical disorder is significant to older adults’ capability in performing more complex sets of activities so as to age in place. The study findings underscore the importance of improving both social and physical aspects of neighborhood environment to facilitate older adults’ daily activity performance.