Abstract
BackgroundA growing number of studies have explored how features of the neighbourhood environment can be related to cognitive health in later life. Yet few have focused on low- and middle-income countries and compared the results across different settings. The aim of this study is to investigate the cross-sectional associations between neighbourhood amenities and dementia in older people from high-, middle- and low-income countries.MethodsThis study was based on two population-based cohort studies of people aged≥65: the Cognitive Function and Ageing Study II (CFAS II) in UK (N = 4955) and a subset of the 10/66 study in China, Dominican Republic and Mexico (N = 3386). In both cohorts, dementia was assessed using the Geriatric Mental State−Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm. The 10/66 dementia diagnostic algorithm was also used as an additional criterion in the 10/66 study. Publicly accessible databases, Google Maps and Open Street Map, were used to obtain geographic information system data on distance to neighbourhood amenities, including lifestyle (cafés, libraries, movie theatres, parks), daily life (post offices, convenience stores), healthcare (hospitals, pharmacies) and percentages of local green and blue spaces within 400 and 800 m of participants’ residences. Multilevel logistic regression was used to investigate the associations between these environmental features and dementia adjusting for sociodemographic factors and self-rated health.ResultsLiving far from daily life amenities was associated with higher odds of dementia in both CFAS II (1.47; 95% CI: 0.96, 2.24) and the 10/66 study (1.53; 95% CI: 1.15, 2.04), while living far from lifestyle (1.50; 95% CI: 1.13, 1.99) and healthcare amenities (1.32; 95% CI: 0.93, 1.87) was associated with higher odds of dementia only in the 10/66 study. A high availability of local green and blue spaces was not associated with dementia in either cohort yet living far from public parks was associated with lower odds of dementia in CFAS II (0.64; 95% CI: 0.41, 1.00).ConclusionsThe different relationships across cohorts may indicate a varying role for local amenities in diverse settings. Future research may investigate mechanisms related to these differences and social, cultural and historical influences on the interaction between neighbourhood amenities and older people.
Highlights
A growing number of studies have explored how features of the neighbourhood environment can be related to cognitive health in later life
Utilising online geographical information system (GIS) data resources and existing ageing cohorts, the aim of this study is to investigate whether a higher availability of local amenities, green and blue spaces is associated with lower odds of dementia in older people living in the UK, China, Dominican Republic and Mexico
Multilevel logistic regression modelling was used to investigate the associations between individual environmental features and dementia and a random intercept was included to take into account the nesteddata structure [25]
Summary
A growing number of studies have explored how features of the neighbourhood environment can be related to cognitive health in later life. Low availability of local food stores and restaurants was found to be associated with an increased risk of developing dementia over a three-year follow-up period in a population-based cohort of 49,511 older adults living in Japan [12] These inconsistencies could be related to variation in research methods across studies, such as crosssectional or longitudinal designs, sampling approaches, assessment methods for exposures, outcomes or other covariates and the availability of data for local amenities at different time points. To disentangle the potential impacts of research methods from true social and cultural variation, it is necessary to use similar or comparable methods to investigate the associations in different study populations across countries or settings
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