Age-Friendly Neighborhoods and Economic Vulnerability

Background and Purpose: There is growing interest among social work scholars in adapting the social and physical environment to promote elder health, well-being, and aging in place by creating more “age-friendly” neighborhoods (Alley, Liebig, Pynoos, Banerjee, & Choi, 2007; Greenfield, 2012; McDonough & Davitt, 2011; Scharlach, 2009). Examples of environmental modifications include opportunities for social integration and meaningful activities; infrastructure changes to create safe neighborhoods; land use designs that promote access to goods and services; and housing options that allows older adults to remain in familiar neighborhoods. To date, however, the impact of environmental modifications on older adults has been understudied, particularly in terms of the effects on economically vulnerable older adults. The purpose of this study was to examine the association between measures of the physical and social environment and health and well-being in a representative sample of urban elders. This paper will focus on how environmental influences on self-rated health differ between low-income older adults and their higher income counterparts. 

Methods: We examined the association between the social and physical environment and elder health through secondary analysis of interview data from 1,372 adults (n=814 low income and n=571 higher income) age 60 and older living in Detroit and geographic data on their surrounding environmental characteristics. Using exploratory factor analysis, we identified six factors that capture the social and physical environment: 1) access to business and leisure, 2) access to health care, 3) neighborhood problems, 4) social interaction, 5) social support, and 6) community engagement. We then conducted separate linear regression models for low income and higher income elders to test the association between these factors and self-rated health, which previous research demonstrates is predictive of mortality, physical disability, chronic disease status, health behaviors, and health care utilization.

Results: For both low-income and higher income respondents, access to health care predicted higher self-rated health (B = .067, SE = .033, p<.05 and B = .213, SE = .077, p<.01, respectively).  Social support was associated with increased self-rated health for low-income elders (B = .128, SE = .040, p<.01), while community engagement predicted higher self-rated health for higher-income elders (B = .114, SE = .050, p<.05). Additionally, the neighborhood problems factor was associated with lower self-rated health (B = -.095, SE = .048, p<.05) only for higher-income respondents.

Conclusions and Implications:  Existing models to create more age-friendly neighborhoods often neglect the potentially unique needs of economically vulnerable older adults.  Findings suggest, however, that financial resources should be an important component of research and interventions on social and physical environmental influences on the health and well-being of older adults. This paper will discuss implications not only for environmental interventions designed to improve health, but also interventions aimed to promote aging in place, a programmatic and policy goal that may not be preferred, optimal or practical for those living in or near poverty.