Perceived neighborhood safety and incident mobility disability among elders: the hazards of poverty.

Cheryl R Clark,Louise Ryan,Karen Ertel,Martha E Fay,Lisa F Berkman,Ichiro Kawachi

doi:10.1186/1471-2458-9-162

Abstract

BackgroundWe 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.MethodsWe 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.ResultsAt 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.ConclusionPerceiving 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.

Highlights

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 found that perceiving safety hazards increased the risk of incident mobility disability among impoverished elders at retirement-age, and that this effect was not completely explained by baseline lifestyle behaviors and co-morbid conditions
Our findings suggest that the effects of neighborhood safety on mobility disability operate through elders' perceptions rather than through direct measures of crime, and that such negative perceptions of safety pose a hazard primarily for retirement-aged elders who are poor

Summary

Introduction

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. An early sign of the disablement process, is defined as difficulty or dependency in functioning due to decreased walking ability, maneuverability, or speed [3,4]. 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 [1,6]. Growing numbers of aging-related disability episodes are expected to increase public costs of care and reduce quality of life for those affected [2]. Identifying population-based factors that trigger the disablement process is important to promoting healthy aging

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