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

Background and Purpose: Activities of daily living (ADL, fundamental functioning) and instrumental activities of daily living (IADL, more advanced tasks) are important indicators of an older individual’s functioning level and his/her capability to live independently in the community. Suggested by the Disablement Process Model, environmental factors such as neighborhood physical characteristics may exert impacts on older residents’ ADL and IADL limitations. However, limited studies have examined the effects of both neighborhood social and physical aspects on older adults’ ADL and IADL limitations. To bridge the gap, the present study aims to examine the effects of neighborhood social cohesion and neighborhood physical disorder on ADL and IADL limitations among older adults. We hypothesize that lower levels of neighborhood social cohesion and higher levels of neighborhood physical disorder are associated with increased number of ADL and IADL limitations.

Methods: Study sample was selected from eight waves of the National Health and Aging Trend Study (baseline N=6,392, 2011 to 2018), a nationally representative sample of older Americans who are Medicare beneficiaries. ADL limitations were measured in four domains: eating, bathing, toileting, and dressing. IADL limitations were measured in five domains: laundry, shopping, meal preparation, banking, and medication. The outcomes were a count of limitations for ADL and IADL respectively. Both neighborhood social cohesion (i.e., neighbors can be trusted) and physical disorder (i.e., vandalism in neighborhood) were measured by validated 3-item scales. Covariates include socio-demographic background, and health and mental health indicators. Mixed-effects negative binomial regressions were conducted to estimate the association of lagged social cohesion and physical disorder in prior wave (period t-1) and the number of ADL and IADL limitations in current wave (period t).

Results: After adjusting for covariates, prior wave social cohesion was associated with lower rate of limitations in ADL (Incidence Rate Ratio [IRR]=0.98, p < 0.01) and IADL (IRR=0.96, p < 0.001). In addition, prior wave physical disorder was only associated with higher rate of IADL (IRR=1.04, p <0.5), but not with ADL. Additionally, significant covariates predicting ADL and IADL limitations included age, education, income, living arrangement, dementia status, number of chronic conditions, incidence of falls, hospitalization, and depressive symptoms.

Conclusions and Implications: This is one of the few studies to investigate the effects of neighborhood characteristics on ADL and IADL limitations with a longitudinal design. The study findings revealed that strong social cohesion among neighbors is a protective factor that reduces the numbers of ADL and IADL limitations. Therefore, neighborhood social cohesion is critical in enabling older adults to live safe, healthy, and independent lives in the community. As for neighborhood physical disorder, findings showed that environmental hazards and physical barriers could be risk factors that disenable older adults’ aging in place. The study findings highlight the usefulness of the Disablement Process Model in studying functional impairment among older adults. The study findings also underscore the importance of improving both social and physical aspects of neighborhood environment to better facilitate older adults’ performance of the major life tasks and promote successful aging.