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There is a positive association between pedestrian infrastructure and aesthetics and the physical function of older adults

Rachele J, Sugiyama T, Davies S, Loh V, Turrell G, Carver A, Cerin E. Neighbourhood built environment and physical function among mid-to-older aged adults: A systematic review Health & place. 2019; 58: 102137.

Review question

•      What are the associations between the neighbourhood built environment and physical function of older adults?

Background

•      Physical function refers to one’s physical ability to carry out various activities, from simple activities like self-care to more vigorous actions that require strength, mobility, and endurance.

•      It is common knowledge that an individual's physical function declines with age. The rate of this decline can be influenced by various lifestyle factors such as physical activity, smoking, diet, and environment, and typically determines when individuals lose independence in their activities of daily living.

•      The neighbourhood built environment is particularly interesting to researchers because it affects older adults’ abilities to age in place. Ageing in place is the ability to continue to live in one's own home and community safely, independently, and comfortably.

•      The built environment refers to the functional aspects of spaces with which we interact. These include characteristics such as residential density, public transport, aesthetics, street connectivity, walkability, land use mix, pedestrian infrastructure, and safety.

•      The association between built environments and health behaviours, and health behaviours and physical function, suggests that the characteristics of living environments affect the rate of decline of physical function.

•      In this review, authors systematically review research examining associations between the neighbourhood built environment and physical function.

How the review was done

•      In July 2018, study authors conducted a detailed search of 9 research databases for suitable research studies.

•      Search terms included: objective environment, spatial, neighbourhood, built environment, walkability, streetscapes, street connectivity, land use mix, physical function, functioning, impairment, disability, and mobility.

•      Studies were included if they were written in English and examined the relationship between the built environment and physical function.

•      13,498 articles were retrieved from the initial search, of which 23 were included in this review.

•      Study authors were supported by the NHMRC Centre of Research Excellence in Healthy, Liveable, and Equitable Communities, as well as the ARC Future Fellowship. The authors declare they have no actual or potential competing interests.

What the researchers found

•      Study authors grouped findings into 8 broad categories: walkability, residential density, street connectivity, land use mix, pedestrian infrastructure, aesthetics, safety from crime, and safety from traffic.

•      Walkability: In one study examining walkability and physical function, authors did not find an association between Walk Score and physical function.

•      Residential density: Two studies examined the relationship between residential density and physical function. Neither study found an association between the two conditions.

•      Street connectivity: Three studies examined street connectivity and physical function. One study found that higher connectivity (reflected in street design and housing stock age) was associated with a reduced risk of limitations in instrumental activities. Another study found that resident of areas with lower street connectivity were more likely to develop two or more lower-body functional limitations than those in areas of higher street connectivity. The final study found an association of greater street connectivity with a slower decline in dynamic leg strength of women.

•      Land use mix: Ten studies examined relationships between land use mix and physical function. Across nine studies, some positive associations were found for access to shops, services and transport, and recreational facilities, medical facilities and community centres, but the large majority of those associations were not significant.

•      Pedestrian infrastructure: Eight studies examined the relationship between pedestrian infrastructure and physical function. In 5 studies, physical function was positively associated with living in neighbourhoods with better street characteristics and benches.

•      Aesthetics and cleanliness: Eleven studies examined aesthetics and physical function. All longitudinal studies found positive associations between the two conditions, with one reporting significant associations between perceived neighbourhood problems and onset of disability, and one finding an association between poor block conditions and increased odds of lower-body functional limitations.

•      Safety from crime: Eleven studies examined some form of safety from crime and physical function. Among these studies, both positive and negative associations between safety from crime and physical function were found, though most findings were insignificant.

•      Safety from traffic: Seven studies examined safety from traffic and physical function. Two of these studies found a positive association, but the remaining studies did not.

Conclusion

•      This review summarized findings from studies examining associations between the built environment and physical function of mid-to-older aged adults.

•      Positive associations were found for pedestrian infrastructure and aesthetics, while weaker evidence was found for land use mix and safety from crime and traffic.

•      There was an insufficient number of studies analyzing walkability, residential density, street connectivity, and public transport.