Neighborhood Environment and Psychological Distress Among Older Adults: The Moderating Role of Economic Vulnerability

Background and Purpose: Neighborhood environments may be even more important for older adults than other age groups - they may have lived in their neighborhood for longer, built close relationships with places and people, and experienced a shrinking activity space because of chronic conditions and limited mobility. Furthermore, a more optimal neighborhood environment may be more beneficial to low-income older adults who lack individual resources. However, previous studies on neighborhood influences on elders’ mental health primarily focus on neighborhood socioeconomic status or collective efficacy. This study investigates whether a more comprehensive set of neighborhood environmental characteristics affects the psychological distress of older adults, with particular attention to the potential moderating role of economic vulnerability on the association between social cohesion and psychological distress.

Methods: We used data from the 2012 National Health & Aging Trends Study (NHATS), a representative sample of Medicare beneficiaries ages 65 or older in the United States. Employing a stratified multi-stage sample design, the NHATS oversampled those ages 90 or older and African Americans to ensure sufficient participation by age and race/ethnicity. To include census tract-level covariates, we merged the NHATS data with the 1970-2010 National Neighborhood Change Database (NCDB) produced by Geolytics, and the Walk Score Database. We included a sample of 5,640 community-dwelling older adults across 3,383 census tracts for our analyses.

We assessed the outcome psychological distress using the Patient Health Questionnaire-4 (PHQ-4) (M=1.9; SD=2.5; range: 0-12). We included seven neighborhood variables: walkability, parks, neighborhood problems, percent vacant housing, social cohesion, urban/rural/suburban, and median household income. Adjusting for individual characteristics (age, gender, race/ethnicity, living alone, high school diploma, economic vulnerability, self-rated health, chronic diseases, and food insufficiency), we ran multiple regression analyses to examine the relationship between neighborhood environment and psychological distress, employing analytic sample weights to estimate Taylor Series standard errors. Additionally, we examined whether economic vulnerability moderated the association between social cohesion and psychological distress.

Results: Higher walk scores were associated with greater levels of psychological distress (β=0.05, p<.001), whereas a greater level of social cohesion was related to a lower level of psychological distress (β=-0.05, p=.002). Compared to urban areas, older adults living in rural areas had a greater level of psychological distress (b=0.32, p=.05). However, park availability, perceived neighborhood problems, percentage of vacant housing, and neighborhood median income were not associated with psychological distress. In addition, economically vulnerable participants living in neighborhoods with higher perceived levels of social cohesion had lower levels of psychological distress compared to those with lower levels of social cohesion.

Conclusions and Implications. This study adds to the growing literature on the role of the neighborhood environment on the psychological distress of older adults. This study found that while social cohesion is a protective factor for the psychological distress of older adults regardless of income, higher levels of social cohesion are more beneficial to those who are economically vulnerable. These findings suggest macro-level interventions that aim to build social cohesion for lower-income older adults may be a promising strategy to promote well-being.