How neighborhoods can protect – or harm – older adults’ cognitive health

Does your neighborhood help protect your cognitive health as you age?

A growing body of research led by scientists at Washington University in St. Louis and the University of Michigan suggests older adults’ access to civic and social organizations, cultural centers – such as museums and art galleries – and recreation centers may help protect against cognitive decline as a person ages; a theory they have called “cognability.”

In a recent study, “Cognability: an ecological theory of neighborhoods and cognitive aging,” published in Social Science & Medicine, the researchers found evidence that these neighborhood features can predict older adults’ cognitive function scores.

“The main goal of this project was to examine a potential connection between older adults’ cognitive health and the neighborhood environments in which they reside,” said study co-author Michael Esposito, assistant professor of sociology in Arts & Sciences at WashU.

Esposito

“And we found evidence of that association: folks living in areas layered with place-based privileges and with minimal exposure to hazards experienced significantly better outcomes than their peers.”

Specifically, people who lived in neighborhoods with ready access to civic and social organizations displayed higher cognitive scores than those who lived in neighborhoods with no immediate access to such organizations. The difference was equivalent to roughly a two-year age difference.

The researchers also showed that people who lived in neighborhoods with high exposure to highways displayed lower cognitive scores than those who lived in neighborhoods with few highways. This again translates to a two-year age difference. Other features, such as neighborhoods with high densities of coffee shops and fast-food establishments, were associated with slightly lower levels of cognitive function.

“There are hints in the literature that neighborhoods actually could play a really big role (in one’s risk for Alzheimer’s and dementia), but they’re largely overlooked. We don’t often pay attention to the neighborhood context for people as they develop and navigate cognitive decline as they age,” said Jessica Finlay, a research investigator at the U-M Institute for Social Research (ISR).

Identifying specific neighborhood features that are most protective of cognitive health among aging adults is important to informing future public health initiatives, community interventions and policy, researchers said.

“These results here are fairly preliminary, setting the stage for additional research on the topic, but demonstrate that inequalities in the neighborhood environment may be a crucial, structural mechanism to understanding larger population health disparities,” Esposito said.

About the research

Esposito and Finlay previously assessed single features of neighborhoods to determine their impact on cognitive function. In the current study, the researchers wanted to compare a collection of 15 features to see which may be most strongly associated with cognitive function among older adults.

The group included cognitive scores from more than 20,000 participants in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a national sample of older Black and white adults in the United States.

Esposito, who led the statistical analysis portion of the study, created a conservative model that assumed none of the 15 neighborhood features impacted cognitive health. Then, using a statistical learning approach, he let the model run through each of the 15 features of a neighborhood’s cognitive function.

“Our starting assumption in the model was that none of these features matters. We only wanted features to remain in the model that have a strong enough association to break free of that assumption,” Esposito said. “In the final output, after we tried to eliminate the association, we can check to see if it’s still there. If it can pass this test, the feature is probably a salient predictor of cognitive health.”

The researchers weren’t able to control for factors such as wealth, which they note likely drives a person’s ability to buy into a neighborhood with greater access to many of these features. But in future work, they plan to test for such indicators, Esposito said.

The fact that we’re living in a country where people’s access to be healthy varies from neighborhood to neighborhood, that health is conditional on where you live, is important to demonstrate.

Michael Esposito

“The fact that we’re living in a country where people’s access to be healthy varies from neighborhood to neighborhood, that health is conditional on where you live, is important to demonstrate,” he said.

The team also ran models to see if differences in cognitive function within neighborhoods existed by race, gender and education (a proxy for socioeconomic status), but these early models didn’t find significant differences.

Future research will focus more specifically on how neighborhoods and cognitive health might vary by race, ethnicity, gender, education and wealth, researchers said.

“This is really groundbreaking work. Cognability helps people to think about their neighborhood environment with respect to their cognitive health,” said study co-author Philippa Clarke, professor of epidemiology at the U-M School of Public Health and research professor at ISR’s Survey Research Center.

“Most research on cognitive function and dementia focuses on mitigating individual risk factors, but cognability redirects attention to those features in the surrounding environment that may go a long way to mitigating cognitive decline with aging.”

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