Types of Livable Communities and Older Adults' Health

Background and Purpose: Quality neighborhood environments are essential for older adults, who are more likely to spend time there. Living in a neighborhood with better built and social environments is associated with better quality of life; however, neighborhoods are multifaceted. For example, a person may live in a neighborhood with good transportation but poor housing. Limited research has examined the relationship between neighborhood type and older adults’ health. This study aims to 1) identify neighborhood types based on the World Health Organization’s age-friendly community (AFC) framework and 2) examine how the type of neighborhood is associated with older adults’ health.

Methods: We merged data from the 2017 AARP AFC surveys and the Livability Index. The surveys sampled 6,670 adults in 14 U.S. metropolitan areas in 2017; the Livability data includes seven livability index scores at the zip code level: housing (affordability and access), neighborhood (access to life, work, play), transportation (safe and convenient option), environment (clean air and water), health (prevention, access to health care, quality of health care), engagement (civic and social involvement), and opportunity (inclusion and possibilities). Indices range from 0 to 100, with higher scores indicating better neighborhood conditions. Our analytical sample included 3,211 adults aged 65+: 65-74 years (58%), 75-85 years (28%), and over 85 years (14%); female (59%). The majority were non-Hispanic White (83%), followed by Hispanic (8%), Black (7%), and other race (2%: Asian, Native American/Alaskan/Hawaiian). Our outcome variable was self-rated health (M=3.5; SD=1.2; range: 1-5), and the seven livability indices were independent variables. Adjusting for individual characteristics (age, sex, race/ethnicity, marital status, education, income, home ownership, employment, social connection, chronic conditions, and caregiving), we used latent class analysis (LCA) with a distal outcome to examine whether neighborhood type was associated with self-rated health.

Results: All model selection criteria and substantive interpretability supported four neighborhood types. Average posterior probability values met >.70 criterion (range: .96 to .98). We labeled neighborhoods: social environments but limited health services (15%), built environments with restricted social environments (28%), quality health services (24%), and social environment with health services (33%). After identifying the unconditional class, we ran an LCA with a distal outcome using the BCH method. Compared to older adults living in a neighborhood with social environments with health services, those living in environments with limited health services (b = -0.21, p < .001) and built environments with limited social environments (b = -0.16, p < .001) had poor self-rated health. Black and Hispanic older adults reported worse health than older Whites. Higher education, income, and social connection were associated with better health status.

Conclusions and Implications: This is one of few studies to examine the association between types of livable communities and older adults’ health. To plan age-friendly environments that better serve older adults, we must understand the multifaceted characteristics of neighborhoods. Because having quality health services and social environments can improve the health of older adults, social work practitioners and policy-makers should work to improve access to healthcare services and provide more opportunities in communities.