Objective and perceived service accessibility and mental health in older adults.

OBJECTIVES: Service accessibility plays a pivotal role in older adults' mental health. However, accessibility measures used in previous studies are either objective or perceived. This study aimed to integrate both objective and perceived measures of service accessibility to explore the relationship between environmental cognition on service accessibility and mental health in older adults and the pathways. METHODS: We used both questionnaire data collected from 2,317 older adults in Hong Kong and geographical data to explore the direct and indirect effect of environmental cognition (i.e. positive, negative, and matching evaluation) relating to service accessibility on mental health and two pathways (i.e. physical activity and sense of belonging) based on a structural equation model. RESULTS: Physical activity mediated the positive relationship between non-negative perceptions toward access to convenience stores, leisure facilities, clinics, community centers, places of worship and mental health. Sense of community can significantly mediate the positive relationships between non-negative perceptions toward all 10 types of services and mental health. CONCLUSION: This study provides an empirical contribution to environmental cognition theory and person-environment fit theory; its findings have implications for urban planning policy.

The findings from this study provide significant evidence that environmental cognition distortion, especially negative perception, can be significantly associated with lower mental health through physical activity and a sense of community. This suggests that policies focused on changing environmental cognitions could be a promising public health strategy. Environmental cognition theory suggests that improving awareness of setting could help improve the precision of cognitive mapping of environmental reality. This can be very important where it is difficult to change the objective environment due to the deep-rooted and long-standing urban structure.

Threats to personhood from within the family? A study of family caregivers of people with dementia in the Chinese context.

BACKGROUND AND OBJECTIVES: Dementia care creates ethical and legal dilemmas due to the struggle to balance the quality of care and personhood. Disagreement and conflict in caregiving relationships are common. However, limited attention has been given to particular stressful circumstances, such as care practice and decision disagreements. Moreover, the cultural context of personhood has been overlooked. This study drew on Hong Kong family caregivers' reports of their cargiving practice and disagreements with care recipients about care-related decisions and their implications for personhood to identify person-centered family care support needs. RESEARCH DESIGN AND METHODS: We conducted 18 semi-structured interviews with family caregivers of people with dementia in Hong Kong, China. Participants were asked to share their family dementia caregiving experience and practice, specifically regarding decisions and practices that elicited disagreement. We used thematic analysis to analyze data generated from interviews. RESULTS: Six caregiver practices were identified: exchange for mutual agreement, a foot-in-the-door approach, acceptance of requests/behaviors contrary to the caregivers' views, infantilization, treachery, and exclusion and imposition. DISCUSSION AND IMPLICATIONS: These findings highlight the importance of providing support and guidelines for person-centered care to promote personhood in the family caregiving context in dementia care.

Universities as Intermediary Organizations: Catalyzing the Construction of an Age-Friendly City in Hong Kong.

Background and Objectives: The construction of an Age-Friendly City (AFC) requires active contribution from relevant interest groups including older adults, nonprofit organizations, and policy-makers. However, given that relevant interest groups may have limited resources, knowledge, and skills, as well as unique contextual factors, they often require help from intermediary organizations-actors that aim to build interest groups' capabilities. Our objectives were to examine the functions of universities, as an example of intermediary organizations, in facilitating the construction of an AFC, and identify critical factors that enable intermediary organizations to perform their functions. Research Design and Methods: We conducted three focus groups and one individual interview with multiple interest groups including older adults and social workers from nonprofit organizations and local government involved in a 6-year citywide AFC project in Hong Kong. Participants were asked to share their views on the role of universities in relation to their own experiences and roles in the project. Data generated from the interviews were analyzed using thematic analysis. Results: Four themes pertinent to the functions of universities in facilitating development were identified: facilitating cross-sector collaborations, knowledge diffusion, interest-group building, and mediating divergent interests. We also found that neutrality and reputability are key characteristics for intermediary organizations to wield sufficient legitimacy to perform their functions efficiently. Discussion and Implications: Findings underscore the important yet overlooked role of intermediary organizations in bridging and mediating different interest groups to facilitate AFC development. We advance gerontological scholarship by providing insights into the theoretical mechanisms and practice implications for intermediary organizations in fostering an AFC.

Neighborhood-Built Environment and Ageism in Later Life.

Ageism is a global challenge and a public health concern that the recent COVID-19 pandemic has further exacerbated. Existing research has mainly focused on individual factors, overlooking the association between the neighborhood-built environment and ageism. This study examined this association and whether its effect varied among areas possessing different socioeconomic characteristics. We conducted a cross-sectional survey of 1278 older people in Hong Kong and merged this with the built environment factors derived from geographical information system data. We used multivariable linear regression to examine the association. Findings revealed that more parks were significantly associated with a lower level of ageism, an impact that remained significant in low-income or low-education areas. Conversely, more libraries in high-income areas were associated with a lower level of ageism. Our findings provide urban planners and policymakers insight into planning for the built environment that reduces ageism enabling older people to achieve a better life.

Neighborhood built environments and cognition in later life.

Objectives: Maintaining good cognition is crucial in later life. However, most existing research has focused on individual factors impacting cognition, and few studies have investigated the association between neighborhood built environment and older adults' cognition. This study examined the association between neighborhood built environment and cognition among community-dwelling older adults and identified variations in this association between different age groups in the older population.Methods: Data were derived from a cross-sectional survey of 1873 people aged 65 years and above in Hong Kong. We merged individual data from the survey with neighborhood built environment data based on community auditing and geographical information system. After controlling for individual covariates, we used multivariable linear regression to examine the association between neighborhood built environment and cognition.Results: Residents aged 80 and younger in neighborhoods with a higher land-use mix and more public transport terminals exhibited better cognition. Only the number of community centers in a neighborhood was positively associated with cognition for people older than 80.Conclusion: The built environment creates diverse impacts on different age groups among older adults. Our findings provide useful information for urban planners and policymakers for planning community facilities and built environments that consider the needs of different age groups within the older population.

The Moderating Role of Community Capacity for Age-friendly Communication in Mitigating Anxiety of Older Adults During the COVID-19 Infodemic: Cross-sectional Survey.

Background: Older adults were perceived as a vulnerable group during the COVID-19 pandemic due to the health and mental health challenges they faced. The pandemic was accompanied by an "infodemic" of overabundant and questionable information that has affected older adults' mental health. As the infodemic and ageist narratives were prevalent online, more anxiety symptoms have been induced among older adults who used social media. Age-friendly communication, advocated by the World Health Organization's Age-friendly City (AFC) guide, could be an antidote by providing tailored information via appropriate channels for older adults. Objective: This study investigated the role of community capacity for age-friendly communication in mitigating anxiety during the pandemic. We hypothesized that age-friendly communication would moderate the effects of infection risks and social media use on anxiety. A double-moderating effect was hypothesized in the context of diminished trust in traditional media. Methods: Data were collected from a cross-sectional telephone survey conducted in Hong Kong in 2020. Older adults (N=3421, age≥60 years) were interviewed about their well-being and daily lives. Community capacity for age-friendly communication was measured in a living district-based evaluation. It had 2 components: the reach of appropriate information to older adults (AFC-Information) and the age-friendliness of communication technologies (AFC-Communication Technology) in the community. We tested the hypothesized moderation and double-moderation effects with ordinary least squares regressions. Results: Perceived COVID-19 infection risk (b=0.002, P=.02) and use of social media for COVID-19 information (b=0.08, P=.04) were associated with more anxiety symptoms. The effect of using social media was moderated by AFC-Information (b=-0.39, P=.002) and AFC-Communication Technology (b=-1.06, P<.001), and the effect of perceived COVID-19 infection risk was moderated by AFC-Information (b=-0.03, P=.002) and AFC-Communication Technology (b=-0.05, P<.001). Lower trust in traditional media exacerbated anxiety symptoms associated with social media use (b=-0.08, P=.02). Higher AFC-Information alleviated this moderation effect (AFC-Information × media trust b=-0.65, P<.001; AFC-Information × social media use b=-2.18, P<.001; 3-way interaction b=0.40, P=.003). Conclusions: Our findings highlight the role of community age-friendly communication in mitigating anxiety related to the infodemic. Although using social media may have exacerbated the impact of the infodemic on older adults, it has the potential to deliver timely information for an adequate health response. Although the amplifying effects of low media trust was associated with social media use, age-friendly communication determined its strength. Instead of discouraging the use of digital technologies for COVID-19 information, efforts should be made in tailoring information and communication technologies in local communities for older adults.

Neighborhood Environment and Mental Well-Being Among Chinese Older Adults: The Mediating Role of Social Capital.

Background and Objectives: Neighborhood environments are increasingly recognized as associated with mental well-being among older adults. However, their underlying mechanisms remain unclear. This study investigated mediating effects of cognitive and structural social capital (SC) in relationships between neighborhood environments and mental well-being among older adults. Research Design and Methods: We conducted a cross-sectional analysis of 1,277 community-dwellers aged 60 years and older in Hong Kong in 2021. The Warwick-Edinburgh Mental Well-being Scale assessed mental well-being. Perceived age-friendly environment was assessed. Objective neighborhood environment was measured by the number of neighborhood facilities (e.g., transportation, community centers, leisure facilities) within 200-m and 500-m buffer areas from respondents' residences. Structural equational modeling was used. Results: Perceived age-friendly environment regarding community and health support had a protective role on mental well-being. More community centers were directly associated with better affective-emotional well-being, while more passive leisure facilities directly lowered psychological-functioning well-being. Cognitive SC outweighed structural SC in mediating relationships of neighborhood environment on mental well-being. Discussion and Implications: Our findings advance the ecological model of aging by providing evidence for cognitive and structural SC as mediators to explain the relationship between neighborhood environment and mental well-being. Policy implications for optimizing mental well-being in aging societies are discussed.

Neighbourhood physical environment, intrinsic capacity, and 4-year late-life functional ability trajectories of low-income Chinese older population: A longitudinal study with the parallel process of latent growth curve modelling.

BACKGROUND: Knowledge of how intrinsic capacity (IC) and neighbourhood physical environment shape functional ability (FA) trajectories in later life remains understudied. We investigated four-year trajectories of IC and their impact on FA trajectories and the association between neighbourhood physical environment and FA trajectories among community-dwelling older adults in Hong Kong, China. METHODS: We conducted a four-wave longitudinal study from 2014 to 2017 in Hong Kong with 2,081 adults aged 65 and above. FA was assessed by The Chinese Lawton Instrumental Activities of Daily Living Scale. We used cognition, affect, locomotion, sensory capacity, and vitality to capture the multiple domains of IC. Neighbourhood physical environment attributes included green space, land use diversity, and availability of facilities, assessed within 200- and 500-meter buffers of respondents' homes. We used the parallel process of latent growth curve model. FINDINGS: IC (Unstandardized coefficient, ß = -0.02, p<0.001) and FA (ß = -0.20, p<0.001) each decreased significantly over time. Individuals with declines in IC experienced a faster decline in FA over time. Green space within a 200-meter buffer (ß = 1.15, p = 0.023), the number of leisure (ß = 0.03, p = .0.043) and public transport (ß = 0.08, p = .0.003) facilities within a 500-meter buffer slowed the rate of FA decline. INTERPRETATION: The level of FA decreased over time in later life. Changes in IC shaped FA trajectories. Increased residential green space and the number of leisure and public transport facilities in the neighbourhood may help slow FA decline over time. FUNDING: The Hong Kong Housing Society.

Longitudinal associations between neighbourhood physical environments and depressive symptoms of older adults in Hong Kong: The moderating effects of terrain slope and declining functional abilities.

Little is known about the accumulative impacts of neighbourhood physical environments on older adults' depressive symptoms over time. Based on a cohort study of 2081 older adults in Hong Kong, this study examined longitudinal relationships between neighbourhood physical environments and depressive symptoms among older adults, with a particular focus on the moderating effects of terrain slope and individual functional ability using latent growth curve modelling. Results indicated that the availability of community centres and passive leisure facilities reduced depressive symptoms over time. The protective effects of residential surrounding greenness on depressive symptoms among older adults differed by the terrain slope types. Longitudinal associations between neighbourhood physical environments and depressive symptoms varied between older adults with and without functional limitations. This study has implications for the Ecological Theory of Ageing by identifying the dynamic interplay of environment demands and individual functional ability. Planning policies for building age-friendly neighbourhoods are discussed.

Neighborhood Built Environment and Late-Life Depression: A Multilevel Path Analysis in a Chinese Society.

OBJECTIVES: Neighborhood built environments (BEs) are increasingly recognized as being associated with late-life depression. However, their pathways are still understudied. This study investigates the mediating effects of physical and social activities (PA and SA) and functional ability (FA) in the relationships between BEs and late-life depression. METHODS: We conducted a cross-sectional analysis with data from 2,081 community-dwellers aged 65 years and older in Hong Kong in 2014. Two road-network-based service area buffers (200- and 500-m buffers) adjusted by terrain and slope from participants' residences were created to define the scope of neighborhoods. BEs comprised population density in District Council Constituency Areas, urban greenness, land-use diversity, and neighborhood facilities within 200- and 500-m buffers. Multilevel path analysis models were used. RESULTS: More urban greenness within both buffers and more commercial facilities within a 500-m buffer were directly associated with fewer depressive symptoms. SA mediated the relationship between the number of community facilities and depressive symptoms within a 200-m buffer. Neighborhood urban greenness and the number of commercial facilities had indirect associations on depressive symptoms within a 500-m buffer, which were mediated by FA. DISCUSSION: Our findings have implications for the ecological model of aging. The mediating effects of SA and FA underscore the importance of promoting active social lifestyles and maintaining FA for older adults' mental health in high-density cities. Policy implications on how to build age-friendly communities are discussed.

Fostering Civic Awareness and Participation Among Older Adults in Hong Kong: An Empowerment-Based Participatory Photo-Voice Training Model.

Social and civic participation are important tenets for both the age-friendly city and active aging frameworks promoted by the World Health Organization. Yet older adults are often under-represented in civic affairs. This study examines the effects of using photo-voice as a method in facilitating older adults' civic participation. Specifically, an empowerment-based participatory photo-voice training model was implemented among older adults with limited formal education in Hong Kong. We conducted three focus groups comprising 12 older adults and one in-depth interview with a social worker. Findings revealed that photo-voice is an effective tool in capturing older adults' views that would have otherwise been difficult to articulate in words or in writing, and in enhancing older adults' ability and willingness to participate in community and civic affairs. These findings underscore the importance of using novel techniques to build a more inclusive society that incorporates the views of older adults.