Environmental effects on cognitive health in older adults: insights for long-term care services

Abstract

The link between environment and health has been widely studied. However, empirical evidence using longitudinal data to understand the effects of environments on cognitive health among older adults is limited. This three-paper dissertation addressed this gap through three related inquiries. The first paper proposed a conceptual framework for understanding the interactions among individual factors, environmental factors, and cognitive health among older adults based on an ecological perspective and current health-related research. Guided by this conceptual framework, the second and third papers used spatial lag of X (SLX) modeling and generalized estimating equation (GEE) modeling to investigate the impact of environmental factors on older adults’ cognitive health in China and the US drawing data from the Chinese Health and Retirement Longitudinal study from wave 1 and wave 3 (N = 15,510) and the Health and Retirement Study in the United States from wave 3 to wave 13 (N = 19,988). Both studies found that older adults living in poor, deprived, or socioeconomically disadvantaged neighborhoods were more likely to have worse cognitive health outcomes compared to older adults living in affluent neighborhoods. The findings of this dissertation suggests that interventions that aim to improve older adults’ cognitive health should not only be delivered at the individual level, but also should be delivered at the community level, such as building an aging-friendly environment, expanding healthcare resources, or increasing food accessibility for senior residents. Implications for future research, social work practice, and policies are also discussed.