The objective of this research is to understand the ways in which neighborhoods influence trajectories of physical and cognitive functioning and health of older men and women. Although much is known about the impact of social conditions and behaviors on the health and well-being of the elderly, less is understood about the residential environments which help to shape those conditions and behaviors. We test a model in which specific characteristics of neighborhoods or communities in which an older person lives can either enable the maintenance of functioning and independent living and serve to promote successful aging or may prove to be deleterious for health and functioning. This project is based on longitudinal data from the New Haven and Duke EPESE (Established Populations for the Epidemiologic Study of the Elderly) a cohort studies. The New Haven EPESE is a study of 2812 men and women 65 and older living in New Haven in 1982 and under continuous surveillance through 1994. The Duke EPESE is a study of 4,162 men and women living in the Piedmont, 5 county region of North Carolina, interviewed in 1986 and followed through 1996. We propose to merge data from these cohorts with ecological-level data from multiple sources including the census, government documents and historical information from the New Haven Regional Data Cooperative.
The specific aims of the study are: A) to refine an innovative conceptual model and set of measures of neighborhood characteristics. Our proposed model is 1) multidimensional spanning social and economic conditions to service-related and physical characteristics and is 2) germane to the study of the elderly. B. to examine the influence of neighborhood conditions on five primary health outcomes using multilevel modeling incorporating both ecological and individual level variables. The five outcomes are: 1) physical functioning, 2) cognitive functioning, 3) mortality, 4) self-rated health and 5) nursing home admissions. C) to identify behavioral (e.g. alcohol and tobacco consumption physical activity) and psychosocial (e.g. social networks, fear of crime, social engagement) pathways through which neighborhood characteristics affect health and functioning. D) to identify particular subgroups of older men and women who may be particularly vulnerable to the effects of neighborhood conditions. We hypothesize that frail and economically disadvantaged older men and women may be at particularly high risk.
