The influence of neighborhood factors on biological measures of stress in home‐dwelling multi‐ethnic older adults with dementia

Abstract

AbstractBackgroundRecently researchers have begun to examine the possible biological pathways through which neighborhood context may affect the health of vulnerable residents. Although stress is often hypothesized to contribute to the effects of neighborhoods on health, no studies have investigated associations of neighborhood characteristics and stress biomarkers in home dwelling persons living with dementia (PLwD). Identifying these biological pathways is fundamental to increasing our understanding of how neighborhoods can influence health and well being in vulnerable residents including those with dementia.MethodsGuided by the National Institute on Minority Health and Health Disparities Framework, this pilot study examined pathways linking both micro (individual level) and macro (neighborhood) level factors in home dwelling PLwD. The model was used to determine what community level factors (density, total crime index, median home value, and noise index) were associated with measures of salivary cortisol controlling for sociodemographics, dementia stage, and comorbid illnesses. The sample included 100 participants: 30 Whites, 39 African Americans, and 31 Latinos with an average age of 73.6. Saliva samples were collected using Salivette collection tubes over two days and stored at −20 °C until analysis.ResultsResidents of neighborhoods with lower housing value and higher noise and density were disproportionately composed of racial/ethnic minorities (with the patterning for Hispanics more pronounced than for blacks.) Significantly lower levels of cortisol at wakeup and a less steep decline was associated with adverse neighborhood environments (higher noise, crime, density, and lower housing value). The strongest relationship between neighborhood characteristics and cortisol levels was found for neighborhood crime. Individuals with dementia residing in higher crime neighborhoods had significant lower levels of cortisol at wakeup and with less pronounced initial declines than those residing in low crime neighborhoods.ConclusionGiven that lower cortisol at wakening and slower rate of decline in cortisol across the day are associated with adverse health outcomes, our analyses can inform the identification of risky communities that are most likely to benefit from health‐supportive community interventions to minimize the negative impacts of unsupportive community environment. These pilot results suggest that further investigation of the effects of neighborhood contexts on stress biomarkers and health outcomes in PLwD is warranted.