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.

The Contribution of Sense of Community to the Association Between Age-Friendly Built Environment and Health in a High-Density City: A Cross-Sectional Study of Middle-Aged and Older Adults in Hong Kong.

Sense of community may be shaped by the quality of the physical environment and has potential health implications. Based on a survey of 2,247 community-dwelling middle-aged and older adults living in Hong Kong, we tested the mediation effect of sense of community on the relationship between the quality of the built environment and physical and mental health using path analysis. The quality of the built environment was indicated by the age-friendliness of outdoor spaces and buildings. No direct association was found between the built environment and health outcomes, although age-friendly outdoor spaces were associated with better mental health. Sense of community mediated 14% of the total effect between outdoor spaces and mental health and 44.8% of the total effect between buildings and physical health, underscoring the importance of accommodating the social needs of middle-aged and older people in urban development in high-density cities.