Associations of changes in neighbourhood walkability with changes in walking activity in older adults: a fixed effects analysis.

BACKGROUND: Supporting older adults to engage in physically active lifestyles requires supporting environments. Walkable environments may increase walking activity in older adults, but evidence for this subgroup is scarce, and longitudinal studies are lacking. This study therefore examined whether changes in neighbourhood walkability were associated with changes in walking activity in older adults, and whether this association differed by individual-level characteristics and by contextual conditions beyond the built environment. METHODS: Data from 668 participants (57.8-93.4 years at baseline) across three waves (2005/06, 2008/09 and 2011/12) of the Longitudinal Aging Study Amsterdam (LASA) were used. These individuals did not relocate during follow-up. Self-reported outdoor walking activity in minutes per week was assessed using the LASA Physical Activity Questionnaire. Composite exposure measures of neighbourhood walkability (range: 0 (low)-100 (high)) within 500-m Euclidean buffer zones around each participant's residential address were constructed by combining objectively measured high-resolution Geographic Information System data on population density, retail and service destination density, land use mix, street connectivity, green space density, and sidewalk density. Fixed effects linear regression analyses were applied, adjusted for relevant time-varying confounders. RESULTS: Changes in neighbourhood walkability were not statistically significantly associated with changes in walking activity in older adults (ß500m = - 0.99, 95% CI = -6.17-4.20). The association of changes in neighbourhood walkability with changes in walking activity did not differ by any of the individual-level characteristics (i.e., age, sex, educational level, cognitive impairment, mobility disability, and season) and area-level characteristics (i.e., road traffic noise, air pollution, and socioeconomic status). CONCLUSIONS: This study did not show evidence for an association between changes in neighbourhood walkability and changes in walking activity in older adults. If neighbourhood walkability and walking activity are causally linked, then changes in neighbourhood walkability between 2005/06 and 2011/12 might have been not substantial enough to produce meaningful changes in walking activity in older adults.

Green spaces, subjective health and depressed affect in middle-aged and older adults: a cross-country comparison of four European cohorts.

BACKGROUND: Studies on associations between urban green space and mental health have yielded mixed results. This study examines associations of green space exposures with subjective health and depressed affect of middle-aged and older adults in four European cohorts. METHODS: Data came from four Western-European and Central-European ageing cohorts harmonised as part of the Mindmap project, comprising 16 189 adults with an average age of 50-71 years. Green space exposure was based on the distance to the nearest green space and the amount of green space within 800 m buffers around residential addresses. Cohort-specific and one-step individual participant data (IPD) meta-analyses were used to examine associations of green space exposures with subjective health and depressed affect. RESULTS: The amount of green spaces within 800 m buffers was lowest for Residential Environment and CORonary heart Disease (Paris, 15.0 hectares) and highest for Health, Alcohol and Psychosocial factors In Eastern Europe (Czech Republic, 35.9 hectares). IPD analyses indicated no evidence of an association between the distance to the nearest green space and depressed affect (OR 0.98, 95% CI 0.96 to 1.00) or good self-rated health (OR 1.01, 95% CI 0.99 to 1.02). Likewise, the amount of green space within 800 m buffers did not predict depressed affect (OR 0.98, 95% CI 0.96 to 1.00) or good self-rated health (OR 1.01, 95% CI 0.99 to 1.02). Findings were consistent across all cohorts. CONCLUSIONS: Data from four European ageing cohorts provide no support for the hypothesis that green space exposure is associated with subjective health or depressed affect. While longitudinal evidence is required, these findings suggest that green space may be less important for older urban residents.

Association between neighbourhood characteristics and antidepressant use at older ages: a register-based study of urban areas in three European countries.

BACKGROUND: Research evidence on the association between neighbourhood characteristics and individual mental health at older ages is inconsistent, possibly due to heterogeneity in the measurement of mental-health outcomes, neighbourhood characteristics and confounders. Register-based data enabled us to avoid these problems in this longitudinal study on the associations between socioeconomic and physical neighbourhood characteristics and individual antidepressant use in three national contexts. METHODS: We used register-based longitudinal data on the population aged 50+ from Turin (Italy), Stockholm (Sweden), and the nine largest cities in Finland linked to satellite-based land-cover data. This included individual-level information on sociodemographic factors and antidepressant use, and on neighbourhood socioeconomic characteristics, levels of urbanicity, green space and land-use mix (LUM). We assessed individual-level antidepressant use over 6 years in 2001-2017 using mixed-effects logistic regression. RESULTS: A higher neighbourhood proportion of low-educated individuals predicted lower odds for antidepressant use in Turin and Stockholm when individual-level sociodemographic factors were controlled for. Urbanicity predicted increased antidepressant use in Stockholm (OR=1.02; 95% CI 1.01 to 1.03) together with more LUM (OR=1.03; 1.01-1.05) and population density (OR=1.08; 1.05-1.10). The two latter characteristics also predicted increased antidepressant use in the Finnish cities (OR=1.05; 1.02-1.08 and OR=1.14; 1.02-1.28, respectively). After accounting for all studied neighbourhood and individual characteristics of the residents, the neighbourhoods still varied by odds of antidepressant use. CONCLUSIONS: Overall, the associations of neighbourhood socioeconomic and physical characteristics with older people's antidepressant use were small and inconsistent. However, we found modest evidence that dense physical urban environments predicted higher antidepressant use among older people in Stockholm and the Finnish cities.

Social and physical neighbourhood characteristics and loneliness among older adults: results from the MINDMAP project.

BACKGROUND: Loneliness is associated with several adverse mental and physical health outcomes in older adults. Previous studies have shown that a variety of individual-level and perceived area-level characteristics are associated with loneliness. This study examined the associations of objectively measured social and physical neighbourhood characteristics with loneliness. METHODS: We used cross-sectional data from 1959 older adults (63-98 years) who participated in the Longitudinal Ageing Study Amsterdam (LASA; wave 2011/12) and the Health and Living Conditions of the Population of Eindhoven and Surroundings study (GLOBE; wave 2014) in the Netherlands. Study-specific loneliness scores were harmonised across both cohort studies and divided into tertiles denoting low, medium and high levels of loneliness. Objectively measured neighbourhood characteristics, including area-level percentages of low educated residents, social security beneficiaries and unoccupied dwellings, average income, crime levels and land use mix, were linked to individual-level data. Multinomial logistic regression analyses were conducted to examine the associations of interest. RESULTS: There was no statistical evidence for an association of the included neighbourhood characteristics with loneliness. Although not statistically significant, the observed associations suggested that participants living in neighbourhoods with more heterogeneous land use mix were less likely to have a medium and high level of loneliness than those living in more homogeneous neighbourhoods in terms of land use mix (ORmedium=0.54, 95% CI=0.18-1.67; ORhigh=0.67, 95% CI=0.21-2.11). CONCLUSION: The results indicate that the included objectively measured social and physical neighbourhood characteristics are not associated with loneliness in old age.

Overview of retrospective data harmonisation in the MINDMAP project: process and results.

BACKGROUND: The MINDMAP project implemented a multinational data infrastructure to investigate the direct and interactive effects of urban environments and individual determinants of mental well-being and cognitive function in ageing populations. Using a rigorous process involving multiple teams of experts, longitudinal data from six cohort studies were harmonised to serve MINDMAP objectives. This article documents the retrospective data harmonisation process achieved based on the Maelstrom Research approach and provides a descriptive analysis of the harmonised data generated. METHODS: A list of core variables (the DataSchema) to be generated across cohorts was first defined, and the potential for cohort-specific data sets to generate the DataSchema variables was assessed. Where relevant, algorithms were developed to process cohort-specific data into DataSchema format, and information to be provided to data users was documented. Procedures and harmonisation decisions were thoroughly documented. RESULTS: The MINDMAP DataSchema (v2.0, April 2020) comprised a total of 2841 variables (993 on individual determinants and outcomes, 1848 on environmental exposures) distributed across up to seven data collection events. The harmonised data set included 220 621 participants from six cohorts (10 subpopulations). Harmonisation potential, participant distributions and missing values varied across data sets and variable domains. CONCLUSION: The MINDMAP project implemented a collaborative and transparent process to generate a rich integrated data set for research in ageing, mental well-being and the urban environment. The harmonised data set supports a range of research activities and will continue to be updated to serve ongoing and future MINDMAP research needs.

Longitudinal effects of urban green space on walking and cycling: A fixed effects analysis.

This study examined whether changes in green space within the living environment were associated with changes in walking and cycling frequencies in a cohort of 3,220 Dutch adults between 2004, 2011 and 2014. Data on self-reported weekly time spent walking and cycling for active commute and leisure were linked to geographic information system (GIS) measures of total green areas within 1000 m buffer zones around each participant's home address, and distance to the nearest green space. First, cross-sectional linear regression models showed no statistically significant associations between green space measures and walking and cycling. Second, fixed effects (FE) models were used to analyze whether changes in green space were associated with changes in walking and cycling, using longitudinal data from respondents who did not relocate over time. As distance to the nearest green area increased by 100 m, individuals spent 22.76 fewer (95% CI: -39.92, -5.60) minutes walking for leisure per week and 3.21 more (95% CI: 0.46, 5.96) minutes walking for active commute. Changes in distance to green space were not significantly related to changes in cycling measures. No clear associations between changes in green areas within 1000 m buffers and changes in walking and cycling were observed. Overall, there was weak evidence of an effect of changes in green space area on changes in walking, and no evidence for cycling.

Effect of changes in green spaces on mental health in older adults: a fixed effects analysis.

BACKGROUND: Urban green spaces have been linked to different health benefits, but longitudinal studies on the effect of green spaces on mental health are sparse and evidence often inconclusive. Our objective was to study the effect of changes in green spaces in the residential environment on changes in mental health using data with 10 years of follow-up (2004-2014). METHODS: Data from 3175 Dutch adults were linked to accessibility and availability measures of green spaces at three time points (2004/2011/2014). Mental health was measured with the Mental Health Inventory-5. Fixed effects analyses were performed to assess the effect of changes in green spaces on mental health. RESULTS: Cross-sectional analysis of baseline data showed significant associations between Euclidean distances to the nearest green space and mental health, with an increase of 100 m correlating with a lower mental health score of approximately 0.5 (95% CI -0.87 to -0.12) on a 0-100 scale. Fixed effects models showed no evidence for associations between changes in green spaces and changes in mental health both for the entire sample as well as for those that did not relocate during follow-up. CONCLUSIONS: Despite observed cross-sectional correlations between the accessibility of green space in the residential environment and mental health, no evidence was found for an association between changes in green spaces and changes in mental health. If mental health and green spaces are indeed causally linked, then changes in green spaces in the Eindhoven area between 2004 and 2014 are not enough to produce a significant effect.

New physical activity spaces in deprived neighborhoods: Does it change outdoor play and sedentary behavior? A natural experiment.

BACKGROUND: We used the introduction of dedicated physical activity (PA) spaces in Rotterdam, the Netherlands, to study the impact of reducing distance to dedicated PA spaces on outdoor play and sedentary behavior, and to evaluate if these effects were similar between population subgroups. METHODS: We included 1841 Dutch children from the Generation R Study who participated at two subsequent measurement waves when the children were, on average, 6.0 and 9.7 years old. None of these children lived within 600 m of a dedicated PA space at baseline, and during follow-up 171 children became exposed to 13 new PA spaces within 600 m from home. Individual-level fixed-effects models were used to evaluate changes in distances (determined by Geographical Information Systems (GIS)) from home to the nearest new dedicated PA space, to parent-reported outdoor play and sedentary behavior. RESULTS: The introduction of a dedicated PA space within 600 m from home, and the reduction of the distance per 100 m, did not affect outdoor play or sedentary behaviors. At p < 0.1, significant interaction terms were found between the introduction of the PA spaces and indicators of family socioeconomic position. Although not statistically significant, stratified analyses showed a consistent pattern, suggesting that reducing the distance to the nearest PA space increased outdoor play for children from parents with lower levels of education. However, they also showed a non-significant increase in sedentary behaviors for children from families with net household income below average Dutch income, and for children from a non-Dutch ethnicity. CONCLUSIONS: Introducing dedicated PA spaces may be a promising approach to increase outdoor play for children from more socioeconomically disadvantaged families, but larger studies are needed to contribute to the evidence.

The Moderating Role of Self-Control and Financial Strain in the Relation between Exposure to the Food Environment and Obesity: The GLOBE Study.

Low self-control and financial strain may limit individuals' capacity to resist temptations in the local food environment. We investigated the moderating role of self-control and financial strain in the relation between the food environment and higher body weight. We used data from 2812 Dutch adults who participated in the population-based GLOBE study in 2014. Participants' home addresses and the location of food retailers in 2013 were mapped using GIS. The density of fast food retailers and the totality of food retailers in Euclidean buffers of 250, 400 and 800 m around the home were linked to body mass index and overweight status. A higher density of fast food outlets (B (95% confidence interval (CI)) = -0.04 (-0.07; -0.01)) and the totality of food outlets (B (95% CI) = -0.01 (-0.01; -0.00)) were associated with a lower body mass index. Stratification showed that associations were strongest for those experiencing low self-control or great financial strain. For example, every additional fast food outlet was associated with a 0.17 point lower BMI in those with great financial strain, while not significantly associated with BMI in those with no financial strain. In conclusion, we did find support for a moderating role of self-control and financial strain, but associations between the food environment and weight status were not in the expected direction.

MINDMAP: establishing an integrated database infrastructure for research in ageing, mental well-being, and the urban environment.

BACKGROUND: Urbanization and ageing have important implications for public mental health and well-being. Cities pose major challenges for older citizens, but also offer opportunities to develop, test, and implement policies, services, infrastructure, and interventions that promote mental well-being. The MINDMAP project aims to identify the opportunities and challenges posed by urban environmental characteristics for the promotion and management of mental well-being and cognitive function of older individuals. METHODS: MINDMAP aims to achieve its research objectives by bringing together longitudinal studies from 11 countries covering over 35 cities linked to databases of area-level environmental exposures and social and urban policy indicators. The infrastructure supporting integration of this data will allow multiple MINDMAP investigators to safely and remotely co-analyse individual-level and area-level data. Individual-level data is derived from baseline and follow-up measurements of ten participating cohort studies and provides information on mental well-being outcomes, sociodemographic variables, health behaviour characteristics, social factors, measures of frailty, physical function indicators, and chronic conditions, as well as blood derived clinical biochemistry-based biomarkers and genetic biomarkers. Area-level information on physical environment characteristics (e.g. green spaces, transportation), socioeconomic and sociodemographic characteristics (e.g. neighbourhood income, residential segregation, residential density), and social environment characteristics (e.g. social cohesion, criminality) and national and urban social policies is derived from publically available sources such as geoportals and administrative databases. The linkage, harmonization, and analysis of data from different sources are being carried out using piloted tools to optimize the validity of the research results and transparency of the methodology. DISCUSSION: MINDMAP is a novel research collaboration that is combining population-based cohort data with publicly available datasets not typically used for ageing and mental well-being research. Integration of various data sources and observational units into a single platform will help to explain the differences in ageing-related mental and cognitive disorders both within as well as between cities in Europe, the US, Canada, and Russia and to assess the causal pathways and interactions between the urban environment and the individual determinants of mental well-being and cognitive ageing in older adults.