Perceived Neighborhood Safety and Incident Mobility Disability Among Elders
Perceived Neighborhood Safety and Incident Mobility Disability Among Elders
Background: We investigated whether lack of perceived neighborhood safety due to crime, or living in high crime neighborhoods was associated with incident mobility disability in elderly populations. We hypothesized that low-income elders and elders at retirement age (65 - 74) would be at greatest risk of mobility disability onset in the face of perceived or measured crime-related safety hazards.
Methods: We conducted the study in the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE), a longitudinal cohort study of community-dwelling elders aged 65 and older who were residents of New Haven, Connecticut in 1982. Elders were interviewed beginning in 1982 to assess mobility (ability to climb stairs and walk a half mile), perceptions of their neighborhood safety due to crime, annual household income, lifestyle characteristics (smoking, alcohol use, physical activity), and the presence of chronic co-morbid conditions. Additionally, we collected baseline data on neighborhood crime events from the New Haven Register newspaper in 1982 to measure local area crime rates at the census tract level.
Results: At baseline in 1982, 1,884 elders were without mobility disability. After 8 years of follow-up, perceiving safety hazards was associated with increased risk of mobility disability among elders at retirement age whose incomes were below the federal poverty line (HR 1.56, 95% CI 1.02 - 2.37). No effect of perceived safety hazards was found among elders at retirement age whose incomes were above the poverty line. No effect of living in neighborhoods with high crime rates (measured by newspaper reports) was found in any sub-group.
Conclusion: Perceiving a safety hazard due to neighborhood crime was associated with increased risk of incident mobility disability among impoverished elders near retirement age. Consistent with prior literature, retirement age appears to be a vulnerable period with respect to the effect of neighborhood conditions on elder health. Community violence prevention activities should address perceived safety among vulnerable populations, such as low-income elders at retirement age, to reduce future risks of mobility disability.
Preventing the onset of mobility disability among elders is a public health priority in the United States (US). Generally, disability can be defined as difficulty or dependency in performing roles and tasks needed for independent living and self-care. Mobility disability, an early sign of the disablement process, is defined as difficulty or dependency in functioning due to decreased walking ability, maneuverability, or speed. Mobility disability often predicts the onset of more severe functional impairment, such as Activities of Daily Living (ADL) disability. Though the incidence of disability in the US is decreasing, the absolute number of disabled older adults is projected to increase as the population ages. Growing numbers of aging-related disability episodes are expected to increase public costs of care and reduce quality of life for those affected. Thus, identifying population-based factors that trigger the disablement process is important to promoting healthy aging.
To this end, the growing socioeconomic status (SES) disparity in aging-related disability among elders is of particular concern. Schoeni et al. report widening SES disparities in the prevalence of disability among older adults in the National Health Interview Survey. Between 1982 and 2002, only small declines in the annual prevalence of disability were seen among low-income elders (-1.38%) compared to higher-income groups (-3.1%). Moreover, using data from the 2000 Census Supplementary Survey, Minkler et al. show a persistent SES gradient in the risk for mobility limitations, with highest risks among elders with low incomes at 150% of the poverty level and below. The connections between low SES and mobility disability are not fully understood. In the US, the associations between low income, for example, and poor health outcomes are attributed to psychosocial conditions (e.g., low position in social hierarchy, high levels of stress, fewer opportunities for social engagement), lifestyle behaviors (e.g., smoking, heavy alcohol use), and material resources (e.g., poor access to health insurance, poor-quality housing, poor-quality neighborhoods). Among lower-income elders, these factors are thought to promote the development of chronic co-morbid conditions and present environmental challenges that trigger and advance the disablement process. Finding specific factors that contribute to risks among low-SES elders is an active area of inquiry.
It is possible that chronic exposure to dangerous neighborhoods may have implications for the onset of mobility disability among low-income elders. Living in dangerous or high-crime neighborhoods is frequently cited as a potential health hazard for low-income elders. An emerging literature examines aspects of disadvantaged neighborhoods (perceived safety, crime, walkability, SES of neighbors) that may promote the onset of mobility disability among low-SES elders. Summary scores and indices that measure aspects of disadvantaged neighborhoods have been associated with risks for mobility disability onset among middle-aged and older adults in cross-sectional and longitudinal studies. However, these studies have not found specific associations between measures of perceived neighborhood safety or neighborhood crime rates and the onset of mobility disability. To our knowledge, direct measures of neighborhood crime rates and individuals' perceptions of safety from crime have not been investigated together in longitudinal studies of mobility disability onset among low-income elders.
Theoretically, chronic exposure to neighborhood crime may contribute to stress, allostatic load, and the onset of co-morbidity. Second, though elders are less frequently victimized by crime than younger adults, crime may expose elders to risk of direct injury leading to mobility disability onset. In addition, lack of perceived neighborhood safety could constrain health-promoting behaviors such as walking, or increase negative coping behaviors such as smoking or alcohol use. Moreover, neighborhoods with high crime rates or a reputation for being "dangerous" may have more difficulty attracting businesses that provide material resources and services. A longitudinal study of how crime rates versus perception of safety affect low-income elders may give insights into whether dangerous neighborhoods "get into the body" to initiate the disablement process and how this might occur (perception of safety versus measured crime level). We note that prior studies of neighborhood safety investigated the impact of safety over short time periods, among relatively high-income cohorts, and focused on either young or broad age groups. National survey data indicate that neighborhood conditions have their greatest effect on adults near retirement age, and may be weak or non-existent among middle-aged adults, and the oldest old.
Thus, here we examine effects of neighborhood crime rates and perceived neighborhood safety hazards due to crime in a longitudinal cohort of retirement-aged and older elders free from mobility disability in the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE). We hypothesize that over an eight-year period, elders who live in high-crime neighborhoods and those who perceive their neighborhoods as unsafe due to crime at baseline will have higher risk of an incident mobility disability event than those who do not. Additionally, we hypothesize that these risks will be particularly salient in low-income populations who are at risk for high exposure and have fewer resources for coping with stress.
Abstract and Background
Abstract
Background: We investigated whether lack of perceived neighborhood safety due to crime, or living in high crime neighborhoods was associated with incident mobility disability in elderly populations. We hypothesized that low-income elders and elders at retirement age (65 - 74) would be at greatest risk of mobility disability onset in the face of perceived or measured crime-related safety hazards.
Methods: We conducted the study in the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE), a longitudinal cohort study of community-dwelling elders aged 65 and older who were residents of New Haven, Connecticut in 1982. Elders were interviewed beginning in 1982 to assess mobility (ability to climb stairs and walk a half mile), perceptions of their neighborhood safety due to crime, annual household income, lifestyle characteristics (smoking, alcohol use, physical activity), and the presence of chronic co-morbid conditions. Additionally, we collected baseline data on neighborhood crime events from the New Haven Register newspaper in 1982 to measure local area crime rates at the census tract level.
Results: At baseline in 1982, 1,884 elders were without mobility disability. After 8 years of follow-up, perceiving safety hazards was associated with increased risk of mobility disability among elders at retirement age whose incomes were below the federal poverty line (HR 1.56, 95% CI 1.02 - 2.37). No effect of perceived safety hazards was found among elders at retirement age whose incomes were above the poverty line. No effect of living in neighborhoods with high crime rates (measured by newspaper reports) was found in any sub-group.
Conclusion: Perceiving a safety hazard due to neighborhood crime was associated with increased risk of incident mobility disability among impoverished elders near retirement age. Consistent with prior literature, retirement age appears to be a vulnerable period with respect to the effect of neighborhood conditions on elder health. Community violence prevention activities should address perceived safety among vulnerable populations, such as low-income elders at retirement age, to reduce future risks of mobility disability.
Background
Preventing the onset of mobility disability among elders is a public health priority in the United States (US). Generally, disability can be defined as difficulty or dependency in performing roles and tasks needed for independent living and self-care. Mobility disability, an early sign of the disablement process, is defined as difficulty or dependency in functioning due to decreased walking ability, maneuverability, or speed. Mobility disability often predicts the onset of more severe functional impairment, such as Activities of Daily Living (ADL) disability. Though the incidence of disability in the US is decreasing, the absolute number of disabled older adults is projected to increase as the population ages. Growing numbers of aging-related disability episodes are expected to increase public costs of care and reduce quality of life for those affected. Thus, identifying population-based factors that trigger the disablement process is important to promoting healthy aging.
To this end, the growing socioeconomic status (SES) disparity in aging-related disability among elders is of particular concern. Schoeni et al. report widening SES disparities in the prevalence of disability among older adults in the National Health Interview Survey. Between 1982 and 2002, only small declines in the annual prevalence of disability were seen among low-income elders (-1.38%) compared to higher-income groups (-3.1%). Moreover, using data from the 2000 Census Supplementary Survey, Minkler et al. show a persistent SES gradient in the risk for mobility limitations, with highest risks among elders with low incomes at 150% of the poverty level and below. The connections between low SES and mobility disability are not fully understood. In the US, the associations between low income, for example, and poor health outcomes are attributed to psychosocial conditions (e.g., low position in social hierarchy, high levels of stress, fewer opportunities for social engagement), lifestyle behaviors (e.g., smoking, heavy alcohol use), and material resources (e.g., poor access to health insurance, poor-quality housing, poor-quality neighborhoods). Among lower-income elders, these factors are thought to promote the development of chronic co-morbid conditions and present environmental challenges that trigger and advance the disablement process. Finding specific factors that contribute to risks among low-SES elders is an active area of inquiry.
It is possible that chronic exposure to dangerous neighborhoods may have implications for the onset of mobility disability among low-income elders. Living in dangerous or high-crime neighborhoods is frequently cited as a potential health hazard for low-income elders. An emerging literature examines aspects of disadvantaged neighborhoods (perceived safety, crime, walkability, SES of neighbors) that may promote the onset of mobility disability among low-SES elders. Summary scores and indices that measure aspects of disadvantaged neighborhoods have been associated with risks for mobility disability onset among middle-aged and older adults in cross-sectional and longitudinal studies. However, these studies have not found specific associations between measures of perceived neighborhood safety or neighborhood crime rates and the onset of mobility disability. To our knowledge, direct measures of neighborhood crime rates and individuals' perceptions of safety from crime have not been investigated together in longitudinal studies of mobility disability onset among low-income elders.
Theoretically, chronic exposure to neighborhood crime may contribute to stress, allostatic load, and the onset of co-morbidity. Second, though elders are less frequently victimized by crime than younger adults, crime may expose elders to risk of direct injury leading to mobility disability onset. In addition, lack of perceived neighborhood safety could constrain health-promoting behaviors such as walking, or increase negative coping behaviors such as smoking or alcohol use. Moreover, neighborhoods with high crime rates or a reputation for being "dangerous" may have more difficulty attracting businesses that provide material resources and services. A longitudinal study of how crime rates versus perception of safety affect low-income elders may give insights into whether dangerous neighborhoods "get into the body" to initiate the disablement process and how this might occur (perception of safety versus measured crime level). We note that prior studies of neighborhood safety investigated the impact of safety over short time periods, among relatively high-income cohorts, and focused on either young or broad age groups. National survey data indicate that neighborhood conditions have their greatest effect on adults near retirement age, and may be weak or non-existent among middle-aged adults, and the oldest old.
Thus, here we examine effects of neighborhood crime rates and perceived neighborhood safety hazards due to crime in a longitudinal cohort of retirement-aged and older elders free from mobility disability in the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE). We hypothesize that over an eight-year period, elders who live in high-crime neighborhoods and those who perceive their neighborhoods as unsafe due to crime at baseline will have higher risk of an incident mobility disability event than those who do not. Additionally, we hypothesize that these risks will be particularly salient in low-income populations who are at risk for high exposure and have fewer resources for coping with stress.
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