Neighborhood Built Environments and Health in Later Life: A Literature Review

Abstract

Objectives:

This literature review aims to assess the current state of the field linking neighborhood environments to later-life health and wellbeing.

Methods:

We used electronic databases (e.g., PubMed, Google Scholar, and ProQuest) to search for studies published between 2010 and 2022 examining associations between neighborhood built environmental variables and later-life physical, cognitive, mental, and social health outcomes.

Results:

Among 168 studies reviewed, the majority were quantitative (n = 144) and cross-sectional (n = 122). Neighborhood environmental variables significantly associated with later-life health outcomes included population density/rurality, walkability/street connectivity, access to services and amenities, neighborhood quality and disorder, and parks/green/blue/open space. Neighborhoods operated through behavioral and biological pathways including hazardous exposures, affective states (e.g., stress and restoration), and lifestyle (e.g., exercise, socialization, and diet).

Discussion:

Neighborhoods and healthy aging research is a burgeoning interdisciplinary and international area of scholarship. Findings can inform upstream community interventions and strengthen clinical care.

Introduction

While a growing body of literature focuses on health in later life, the everyday contexts in which older adults develop and navigate health conditions are often overlooked. Aging does not happen in a vacuum devoid of context. Rather, neighborhood environments fundamentally impact health and wellbeing across the lifespan to shape distinct ways of growing old. To complement and extend individual-level interventions that tackle later-life health risks, it is essential to advance understanding of upstream neighborhood exposures that may shape these risks. Diverse and varying neighborhood environments, including the over-concentration of hazards in underserved communities shaped by historical systems of racism and classism, may significantly contribute to health inequities in later life (Finlay, Esposito, et al., 2022).

Older adults may be more reliant on neighborhoods than younger cohorts because their spatial area of daily activity (“life space”) can shrink due to retirement or limited mobility (Yen et al., 2009). Neighborhoods may present multiple obstacles and opportunities to both support and hinder health. Groundbreaking studies in the early 2000s investigated the association between built environments and older adult physical health, including the Alameda County Study (Balfour & Kaplan, 2002) and Baltimore Memory Study (Glass et al., 2006). Early research studying neighborhoods and health found multiple supportive characteristics including green space, mixed-use design (Frank et al., 2004), accessible transportation and safe streets (Doyle et al., 2006), and social interaction opportunities. Research also focused on the health benefits of frequenting neighborhood places, including increased physical activity, reduced stress and depression, enhanced social networks, and a boosted sense of community (Gardner, 2011).

Key Conceptual Frameworks

Social epidemiology has increasingly focused on neighborhoods as social determinants of health. The Ecosocial Theory (Krieger, 2001) posits that health and health inequalities are the result of both individual and socially structured exposures (influenced politically, economically, and ecologically) from micro to macro-levels throughout the life course. Neighborhoods possess both physical and social attributes that influence health and health inequalities. Diez Roux and Mair (2010) proposed a model through which residential segregation shaped by systemic racism and classism caused the unequal distribution of resources within neighborhoods (e.g., recreational facilities, natural spaces, and quality of housing). Individual-level characteristics, including material/psychosocial resources and biological attributes, moderate the relationship between neighborhood environments and health.

In the field of environmental gerontology, Lawton and Nahemow (1973) described behavior and wellbeing among older adults as a function of personal capabilities (e.g., mobility, cognitive abilities, and social skills) and environmental press, which ranges from aspects of the home (e.g., layout and falling hazards) to the community (e.g., availability of resources/services). This evolved into the Ecological Theory of Aging and additional person-environment (P-E) fit approaches to conceptualize how older adults’ behavior and wellbeing depend on the level of environmental press and personal capabilities to overcome obstacles. Chaudhury and Oswald (2019) expanded the components of P-E interactions to include individual characteristics (e.g., physical health, cognitive status, and functioning), social factors (e.g., social support, living arrangement, and caregiver), physical/built environment (e.g., home, neighborhood, and care facility), and technological systems (e.g., ambient/wearable sensors, handheld devices, and GPS). In this body of literature, physical and social neighborhood factors dynamically interact with each other to influence opportunities and barriers for health, mobility, identity, and autonomy in later life.

In geographical gerontology, geographers often focus on how the neighborhood environment may influence older adults’ interactions, attitudes, and behaviors through place attachment and “being in place.” This refers to a sense of belonging, involvement, purpose, and meaningful connection with an environment based upon meanings ascribed to the setting. We uniquely experience and react to places (Relph, 1976). Over time, “being in place” facilitates place attachment: rich emotional ties to particular places, a sense of “insideness” and feeling “at home” (Rowles, 1978). Place attachment may promote older adults’ involvement with their communities and reduce perceptions of loneliness, isolation, and other negative health outcomes. Conversely, qualitative geographic research identifies how being “out of place” can result in discomfort, isolation, and poor health (Finlay & Rowles, 2021).

Neighborhood Built Environments and Health

This paper transcends disciplinary boundaries to synthesize diverse health outcomes, mixed methodological approaches, complexities of neighborhood measurement, and recent findings across relevant fields. It is the first study, to our knowledge, to critically examine the breadth of research investigating neighborhood built environments and later-life physical, cognitive, mental, and social health. The results bring together a constellation of both positive and negative environmental features to help elucidate potential pathways and advance conceptual understanding of how neighborhoods and health are inextricably linked in later life.

Methods

We conducted a thorough search of public health, geographical, and gerontological research using electronic databases including Google Scholar, PubMed, MEDLINE, PsychARTICLES, and ProQuest. Each author conducted a literature review search for evidence on neighborhoods, aging, and health outcomes among studies first published online between 2010 and 2022.¹ Inclusion of articles required English-only text with full article availability that examined associations between the neighborhood built environment and physical, cognitive, mental, or social health in later life (Table 1). We included quantitative, qualitative, and mixed methods studies. The authors created a charting table to extract data from included full-text sources. We followed and expanded the JBI Reviewers’ Manual (Peters et al., 2015) protocol to chart the following key information for each source: (1) authors, (2) year of publication, (3) title, (4) site of data collection, (5) study population, (6) methodology, (7) health outcome measures, (8) neighborhood definition, and (9) key summary findings.

Table 1.

Health Domain-specific Literature Review Search Terms.

Health domain	Search terms
Physical health	Neighborhood built environment (and) physical health (and) older adults
Cognitive health	Neighborhood built environment (and) cognition (or) cognitive function (or) cognitive decline (or) dementia (and) older adults
Mental health	Neighborhood built environment (and) mental health (or) mental disorder (or) wellbeing (or) psychosis (and) older adults
Social health	Neighborhood built environment (and) social isolation (or) loneliness (or) social support (or) social participation (or) social engagement (and) older adults

Results

We reviewed 168 distinct studies² to assess the current state of the field linking neighborhoods and health in later life. The neighborhood built environment included a blend of positively-hypothesized features (e.g., walkable streets, access to services and amenities, parks, and green space), as well as negatively-hypothesized features (e.g., trash, broken sidewalks, lack of gathering spaces, and inadequate service provision). Studies typically investigated potential associations between neighborhood features and health outcomes through behavioral and biological pathways including hazardous exposures, affective states, and lifestyle activities (Figure 1). In the following sections, we evaluate links between specific neighborhood features and physical, cognitive, mental, and social health outcomes.

Figure 1.

Conceptual model of neighborhood environments and health in later life.

Physical Health

We identified 48 studies exploring associations between characteristics of the built environment and older adult physical health outcomes (Table S1). The vast majority used quantitative (n = 47) methods. Of these, 31 were cross-sectional, 14 longitudinal, and two case-control studies. Half of the studies collected data in East Asia (n = 26), followed by North America (n = 10), South America (n = 6), Oceania (n = 3), and Europe (n = 3). It is important to note that this portion of the review does not examine health behaviors such as physical activity or dietary intake influenced by neighborhood characteristics, but solely diagnosed health outcomes. This review only incorporates these factors when they operate as mediators along the causal pathway between the built environment and subsequent health outcomes.

Overall Self-Rated Health.

Of the thirteen studies that examined associations between the built environment and self-rated health, most focused on greenness, safety, and park access. Increased green and open spaces, park access, neighborhood safety, aesthetics, and age-friendliness of the physical environment were all associated with better self-rated health among older adults (e.g., Parra et al., 2010; Ying et al., 2015; Zhang et al., 2021). Focus group participants in Singapore reported that pedestrian-friendly, social, and public spaces; safety; amenities; and transport infrastructure were the most important built environment factors for their physical health (Bhuyan & Yuen, 2022).

Another group of studies examined the role of neighborhood amenities and street connectivity on self-rated health. For example, Li et al. (2022) found that street connectivity, land use mix, and shorter distance to transit were positively associated with self-rated health, which may be mediated by physical activity. Spring (2018) found that long-term exposure to neighborhood environments lacking health-supportive services (i.e., physicians, pharmacies, and senior centers) and those that were commercially declined (i.e., many liquor stores, pawn shops, and fast-food restaurants) were associated with reporting fair or poor self-rated health.

Metabolic Conditions.

Among twelve papers reviewed on the relationship between the neighborhood built environment and metabolic health, the majority (n = 11) focused on obesity. King et al.’s (2011) multi-sited US study found that obese participants were more likely to live in neighborhoods that were high income with low walkability, or low income with high walkability based on residential density, retail floor area ratio, land use mix, and intersection density. Greater density of physical activity facilities was inversely associated with obesity across three US states (Troped et al., 2014). Pruchno et al. (2014) found that the density of fast-food establishments and retail stores was positively associated with obesity, whereas supermarket density was not. Outside of the US, proximity to rivers, parkland, greater open space, and land use mix was negatively associated with obesity (e.g., Ying et al., 2015). Xiao et al.’s (2022) study in Shanghai found that physical activity played a large mediating role between BMI and the density and accessibility of gyms, parks, and fast-food restaurants, while urban parks had both direct and indirect effects on BMI through physical activity. In Brazil, Araújo et al. (2018) found that more paved streets and local commerce were negatively associated with obesity among women; for men, obesity was also negatively associated with better street connectivity and greater street density and lighting.

Frailty, Disability, and Physical Function.

Fourteen studies found associations between environments and general frailty, disability, and poor physical function. Soma et al. (2017) found that lower population density, fewer daily life-related destinations (i.e., community centers and medical and recreational facilities), and lower land use mix were associated with reduced physical functioning among older adults in rural Japan. Also in Japan, Koohsari et al. (2020) found that greater population, intersection density, and neighborhood walkability were associated with better physical function only among men.

Disability was typically evaluated by activities of daily living (ADLs) and instrumental activities of daily living (IADLs). In Brazil, Danielewicz et al. (2018) found that hills were positively associated with disability incidence, while perceived safety of walking at night and a high proportion of commercial areas were negatively associated with disability incidence. Song et al. (2020) found that transport-related physical activity mediated the relationship between neighborhood safety, availability of local commercial services, and distance to the nearest transit station and functional capability in Singapore.

Frailty was measured in a variety of ways encompassing multiple domains including strength, fatigue, nutrition, falls, memory, comorbidities, and activity. Martins et al. (2021) found that perceived neighborhood attributes as well as land use mix diversity, land use mix, street connectivity, walking infrastructure, aesthetics, and crime safety were associated with lower frailty scores among community college students ages 60 to 89 in Nagoya, Japan. Among frail older adults in Hong Kong with caregivers, Chen et al. (2022) found that more facilities offering services and groceries, a shorter distance to the nearby metro station, and greater exposure to greenery were associated with better health outcomes.

Four studies examined the occurrence or fear of falls and injuries in relation to the built environment. Perceived neighborhood walking conditions, accessibility, safety, and outdoor gym facilities were negatively associated with the fear of falling (Canever et al., 2021; Curl et al., 2020). Lee et al. (2020) found that general traffic volume and the presence of bus stations, four-way intersections, department stores, banks, traditional markets, religious institutions, pubs, hospitals, multi-family housing, commercial land use, and office land use were associated with older adult pedestrian accidents. Lee and colleagues (2022) found that while increased tree canopy cover over streets was associated with a decrease in older adult falls, this inverse relationship was only significant during the leaf-on season in the spring and summer. The association was stronger in low-income versus high-income areas.

Chronic Illness.

Four studies identified significant associations between environmental characteristics and prevalent or incident chronic conditions. In Seoul (South Korea), Kim and Ahn (2018) found that severe asthma was associated with population and bus stop density, but negatively associated with availability of active transportation. Clarke et al. (2023) found that risk of type 2 diabetes among older adults with visual impairment was significantly associated with residence in neighborhoods with greater intersection density and high-speed roads, whereas access to broadband internet, optical stores, supermarkets, and gyms/fitness centers were protective. In Australia, participants who reported a lack of local amenities and high-crime rates were at greater risk of developing type 2 diabetes (Dendup et al., 2019).

Mortality.

Three studies found associations between all-cause and cause-specific mortality and built neighborhood environments. Greater vegetation was associated with lower risk for mortality over longitudinal follow-up in China (Ji et al., 2019). In Hong Kong, greater regional air pollution and daily ozone levels were associated with higher dementia mortality, while urban compactness and greenness were associated with lower dementia mortality (Ho et al., 2020). Lin, Leung, et al. (2021) found that those living in areas with greater commercial and residential land use were at lower risk of mortality than those living in areas with greater green space, and these associations were modified by socioeconomic status.

Cognitive Health

We found 42 articles that examined the neighborhood built environment and cognitive functioning among older adults (Table S2). Most were quantitative (n = 38) and longitudinal (n = 25). Twenty-three studies were conducted in North America (n = 17 in the United States, n = 3 in Canada, n = 2 in Mexico, and n = 1 in Dominica). Twelve studies were conducted in Asia (China n = 6; Japan n = 4; Singapore n = 1, and Hong Kong n = 1), eight studies in Europe (United Kingdom n = 7; Republic of Ireland n = 1), and two in Australia.

Cognitive Impairment.

Six studies focused on the development of cognitive impairment. Wu et al. (2015) found that higher land use mix was not associated with cognitive impairment in a UK cohort. However, in a follow-up study, they found that higher land use mix was associated with lower odds of cognitive impairment, while higher quantile of the natural environment was associated with higher odds of cognitive impairment (Wu et al., 2017). In a study by Zhu et al. (2019), increased neighborhood greenness was associated with better cognitive function and lower odds of cognitive impairment among older adults in China. Koohsari et al. (2019) found a significant negative association between greater street integration and odds of cognitive impairment, but no association with intersection density.

Dementia.

Eleven studies investigated links between neighborhood built environments and incidence of dementia. The majority (n = 7) focused on neighborhood greenness. Several found that neighborhood greenness was associated with a lower dementia risk (Astell-Burt et al., 2020; Paul et al., 2020; Yuchi et al., 2020). Yuchi et al. (2020) found that increased neighborhood greenness was associated with a decreased hazard of non-Alzheimer’s dementia but an increased hazard of Alzhiemer’s disease in Vancouver, Canada. This is similar to Wu et al. (2015), who found that greater natural environment (including greenspace and private gardens) was associated with higher odds of dementia in the UK. However, subsequent studies found no association with the natural environment and dementia (Wu et al., 2017; Wu et al., 2020).

Higher levels of air pollution (Bagheri et al., 2021), more social fragmentation (Bagheri et al., 2021), and lower availability of healthy food stores (Tani et al., 2019) were associated with increased risk of dementia. Increased neighborhood walkability was associated with increased odds of dementia in an Australian cohort (Bagheri et al., 2021), but lower odds of dementia in a study among older adults in China (Guo et al., 2019).

Global and Domain-Specific Cognitive Function.

Most cognitive health studies reviewed (n = 27) investigated the association between neighborhood environments and global or domain-specific cognitive function. Global cognition was measured using a variety of cognitive batteries including the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA). Of these studies, over half (n = 16) were longitudinal.

The majority (n = 13) assessed how neighborhood physical facilities and social resources could impact the cognitive function of older adults. These included commercial facilities such as supermarkets, civic centers, and leisure facilities. Clarke et al. (2012) found that higher concentration of cultural facilities was associated with higher cognitive function, while a greater number of community centers was associated with slower rates of decline (Clarke et al., 2015). Similarly, Finlay, Esposito, et al. (2022) found that access to civic/social organizations, recreation centers, arts centers, and museums were significantly positively associated with cognitive function. However, Besser et al. (2018) found that older adults who lived in areas with higher social (e.g., beauty shops/barbers and performance-based entertainment) and walking (e.g., postal services and non-beverage eating/dining places) destination density had lower global cognitive scores. When Besser, Chang, Evenson, et al. (2021) examined the longitudinal association, they found no association between the built environment and maintained or improved global cognition but found a slight association between greater walking destination density and maintained/improved processing speeds. Outside of Western contexts, higher land use mix was associated with better cognition among older adults in Hong Kong (Chan et al., 2023), and better memory, visuospatial, and language scores among older adults in Singapore (Ng et al., 2018).

Four studies utilized a mixed-methods approach integrating qualitative interviews and ethnographic fieldwork with quantitative survey data. In interviews, older adults identified eateries, parks, recreation centers, and civic/social organizations as popular destinations and possible sources of wellbeing (Finlay et al., 2021; Finlay, Esposito, Li, Kobayashi, et al., 2021; Finlay et al., 2020). In subsequent quantitative analyses, these studies found that higher density of local eateries (Finlay et al., 2020), greater number of parks, increased business and recreation center density (Finlay et al., 2021), and more senior centers and civic/social organizations (Finlay, Esposito, Li, Kobayashi, et al., 2021; Finlay, Esposito, et al., 2022) were positively associated with cognitive function.

Five studies examined the association between neighborhood greenness and cognitive function. Among older UK adults, Cherrie et al. (2018) found that childhood and adulthood park availability had an increasingly advantageous effect on cognitive function from ages 70 to 76. Furthermore, park availability during adolescence was associated with better cognitive aging to a greater extent than childhood park availability, with this association being slightly higher among female participants compared to male participants (Cherrie et al., 2019). Similarly, De Keijzer et al. (2018) found that increases in neighborhood greenness was associated with better global cognition, reasoning, and fluency scores among 10,000 British civil servants, with this association being stronger among women than men. Besser, Chang, Evenson, and colleagues (2021) also found a positive association between greater park access and maintained and improved global cognitive function among older adults in the US.

Nine studies explored the role of street layout, physical disorder, and urbanicity on cognitive function with mixed results. Luo et al. (2019) found that more days that roads were impassable were associated with worse cognition at baseline, while better access for those with disabilities and more bus lines were associated with a slower rate of cognitive decline. Among older adults in Kansas (USA), Watts et al. (2015) found that greater neighborhood integration was associated with worse baseline cognition, but neighborhood connectivity was associated with better cognition. Physical disorder and noisy environments were negatively associated with cognitive function (H. Lee & Waite, 2018; Weuve et al., 2021).

Mental Health

We reviewed 41 articles on mental health and neighborhood built environments (Table S3). Most studies utilized a quantitative approach (n = 36), while three studies were qualitative and two were mixed methods. Most studies identified were cross-sectional (n = 39). Studies were mostly conducted in Asian (n = 22) and Western contexts [Europe (n = 8); North America (n = 8); and Oceania (n = 3)]. The countries with the most publications were China (Mainland China n = 8; Hong Kong n = 7; Taiwan n = 1); the US (n = 5); and the UK (n = 3).

Depression and Depressive Symptoms.

The most frequently assessed mental health outcomes were depression and/or depressive symptoms (n = 18). Several studies collected data on these outcomes utilizing validated instruments, such as the short form of the Center for Epidemiologic Studies-Depression Scale (CES-D). In a few studies, researchers used both self-reported and validated instruments.

Six studies focused on the relationship between green spaces and depression or depressive symptoms. Five found that a greater number or proportion of urban greenness in participants’ neighborhoods was associated with less depression (e.g., Abraham Cottagiri et al., 2022). Some studies reported differences by population sub-groups and geography, such as rurality (Bustamante et al., 2022).

Several studies focused on land use. One study found that higher land use mix was associated with greater odds of depression, independent of street connectivity or residential density (Saarloos et al., 2011). Similarly, results from Huang et al. (2021) indicated that cultural/historical facilities and recreational areas were significantly associated with an increased risk of depression. Contrasting findings described a negative association between older people’s depressive symptoms and the availability of amenities (Gillespie et al., 2017) including medical facilities, schools, grocery stores, government offices, senior centers, and public transportation hubs (e.g., Huang et al., 2021; Kim et al., 2022). One study found an association between urbanicity and depression, and an inverse association with roadway distance and depression (Pun et al., 2019). This relationship was partially explained by air pollution and individual characteristics such as loneliness.

Other studies utilizing self-perceived measurements of undesirable neighborhood characteristics such as unsafe traffic, noise, and pollution identified a positive association with depressive symptoms. Andrews et al. (2021) found that objective neighborhood scores (walkability, transportation, crime) were not significant. In contrast, Khosravi and Tehrani (2019) identified spatial stimulation, safety, and walkability as the key neighborhood factors promoting older adults’ mental health, although they identified a stronger influence of social environmental determinants. Lu et al. (2021) found that more urban greenness and more commercial facilities were associated with fewer depressive symptoms.

A European study by Domènech-Abella et al. (2020) found that higher walkability was related to lower levels of loneliness, particularly among those with depression. However, results also indicated that people with high levels of loneliness and high levels of built environment usability had higher probabilities of depression.

Anxiety.

Six of the studies reviewed considered anxiety outcomes in combination with at least one other mental health outcome. For instance, Pun et al. (2019) found an inverse association between roadway distance and anxiety although the associations became non-significant when adjusted for road traffic or noise and no association was found with anxiety and urbanicity in the general sample. In the same study, results from a sub-sample of individuals (i.e., younger age and diabetes history) indicate urbanicity was associated with reduced anxiety. Similarly, Bustamante et al. (2022) showed an inverse association between anxiety and number of neighborhood parks during the COVID-19 pandemic in the US. Khosravi and Tehrani (2019) found that neighborhood road safety was associated with anxiety symptoms in Iran.

Affective Responses and Emotional Wellbeing.

Sixteen studies assessed the relationships between participants’ neighborhood characteristics and their emotional wellbeing (n = 10) or affective responses (n = 6). Data on emotional wellbeing outcomes was collected utilizing mental health parameters embedded in quality-of-life measurement instruments or single-item questions focused on happiness, sense of purpose, and/or meaning in life.

Overall, the studies suggest complex relationships between the built environment and mental health. For instance, Yue, Yang, Owen, and Van Dyck (2022) identified contrasting significant associations according to perceived or objective measurements of older populations’ built environments. Overhead greenspace views had stronger associations with emotional wellbeing than street views, and streetscape grasses had stronger associations than streetscape trees. Regarding land use mix and accessibility to diverse services, findings from Yu et al. (2017) suggest that a significant positive relationship exists, while evidence from Y. Zhao and Chung (2017) indicates no association. Findings from C. Zhang et al. (2019) and Guo et al. (2021) describe a dose-response relationship between mental health and the density of neighborhood entertainment services and street connectivity, respectively.

Studies included quantitative measurements of affective responses to the built environment. For example, Lu et al. (2022) investigated the mental restoration effects of small public urban green spaces (SPUGS) among older adults in Tokyo. Restoration and vitality scores increased when older adults remained in the SPUGS for over 30 minutes, and relevant characteristics of the space included green views, colorfulness index, sky views, water features, boundary enclosure and number of seats. In a mixed-methods study by Tilley et al. (2017), participants preferred green urban spaces, while busy urban spaces were perceived as demanding higher cognitive tasks, potentially leading to more negative mood states.

Studies that were fully qualitative or included a qualitative component provided the opportunity for researchers to explore in-depth how aging people relate neighborhoods to their mental wellbeing. Overall, findings from this group of studies showcase heterogeneous person-place encounters and mobility networks that may enable older people’s psychological wellbeing, although this is recognized as overlapping with social and physical health (Bustamante et al., 2022; Finlay et al., 2015). The pathways identified include opportunities for emergence of positive emotions (e.g., feelings of renewal, restoration, and rejuvenation), moderation of negative affect (e.g., relaxing or stress reducing qualities), as well as opportunities that facilitate aging in place through promoting older people’s sense of independence, agency, and purposeful activities.

General Mental Health and Psychological Distress.

We identified eight studies that assessed overall mental health (n = 7) and/or psychological distress (n = 2). In the UK, living in neighborhoods with higher land use diversity and higher street network connectivity was associated with poorer mental health outcomes (Sarkar et al., 2013). However, findings from other studies suggest that the association might not be straightforward. For instance, Firdaus (2017) suggests poor mental health conditions were associated with commercial areas, while religious places and playgrounds were associated with positive mental health. Meanwhile, a comparative study between local and floating “laopiao” residents in Nanjing, China, suggested these groups may have different expectations towards the built environment, where lower density of street network contributed to better mental health among locals but had the opposite association among the “laopiao” (Tang et al., 2022). Regarding the influence of social factors, two studies suggested that the relationship between older people’s mental health and neighborhood built environments is mediated by social connections (e.g., social interactions and loneliness [Domènech-Abella et al., 2020; Zhou et al., 2020]). Additionally, several studies found associations between mental health and neighborhood safety (e.g., fear of crime, violence, or vandalism [e.g., Domènech-Abella et al., 2020; Firdaus, 2017]).

Five studies explored the association between mental health and green space. Findings suggest that proximity to green spaces was associated with positive psychological wellbeing (e.g., Firdaus, 2017; Tang et al., 2022). However, other cross-sectional studies found no significant associations (e.g., Sarkar et al., 2013; Zhou et al., 2020), while a longitudinal study found no evidence of causality between shifts in participants’ mental health and changes in the distance to the nearest green space (Noordzij et al., 2020). In relation to blue spaces, a Hong Kong study found that visiting blue spaces regularly for recreation was associated with a lower risk of depression and better psychological wellbeing (Garrett et al., 2019).

Social Health

We reviewed 40 articles examining the neighborhood built environment and later-life social health outcomes including isolation, loneliness, social support, and social participation (Table S4). Over half (n = 24) of articles were quantitative, thirteen qualitative, and three mixed methods. Nearly all were cross-sectional analyses (n = 38), and 39 measured the neighborhood built environment at one time point. Most studies were conducted in Western contexts. This includes 20 studies from North America (eleven from the USA and nine from Canada) and twelve from Europe (countries represented included the United Kingdom [n = 3], Spain [n = 2], and Finland [n = 2]). Seven studies were situated in Asian countries including Singapore (n = 3), China (n = 2), and Japan (n = 1).³

It is important to note that social health is significantly linked to mental health and can act as a mediator through which the neighborhood built environment influences mental health outcomes. For example, neighborhood features such as more greenspace or better access to community centers can facilitate opportunities for older adults to engage with others and reduce feelings of isolation and loneliness, which subsequently can reduce risk of anxiety and depression.

Social Participation and Engagement.

The most frequently assessed social health outcome was social participation and engagement (n = 16) through a mix of validated instruments, frequency of self-reported social activities, and qualitative perceptions of social engagement. Most studies focused on meso-scale access to services and amenities. Greater perceived and objective proximity to resources (e.g., libraries, community centers, recreation, and shopping centers), robust transportation infrastructure, and population density were associated with greater social participation (e.g., Levasseur et al., 2020).

Qualitative studies also focused on links between social participation and access to services and amenities including safe and affordable transportation. Open spaces, walkability, and parks were important to social interactions (e.g., Schmidt et al., 2019)–especially since COVID-19 (Finlay, Esposito, et al., 2022). Multiple studies identified “third places” (sites outside of home and work [Oldenburg, 1999]) as facilitators of social engagement and participation. They supported planned and impromptu social engagement (both direct and ambient social contact), particularly among those living alone (e.g., Finlay et al., 2021; Torres, 2019).

Studies also assessed physical disorder (e.g., graffiti, litter, and broken curbs), neighborhood quality (e.g., attractiveness, cleanliness, safety, and sidewalk quality), and environmental barriers. In a national US study, Latham and Clarke (2018) found that neighborhood disorder was associated with decreased odds of visiting family and friends, participating in organizations, and going out for enjoyment. A Chicago-based (US) study by Lai et al. (2019) unexpectedly found that neighborhood disorder was positively related to social activity engagement among older Chinese immigrants. The authors posited that Chinese older adults may live in ethnic enclaves which are underserved, but the high co-ethnic density could promote higher levels of social engagement. They also speculated whether people participating in more social activities may observe or notice neighborhood disorder more than those spending more time at home.

Loneliness.

Twelve studies on the neighborhood built environment and loneliness largely focused on perceived neighborhood quality and access to services and amenities. Residential satisfaction and perceived neighborhood quality played a protective role against loneliness (e.g., Kearns et al., 2015). Wee et al. (2019) found that staying in a poorer physical environment and perceptions of neighborhood disorder (e.g., litter, poorer street lighting and signage, and absence of people on the street or in common areas) were associated with loneliness. Studies identified the potentially protective role of urban density and access to services/amenities against loneliness (e.g., Domènech-Abella et al., 2020). Finlay and Kobayashi’s (2018) mixed-methods study found that the odds of reporting loneliness increased with each additional move “outwards” from the Minneapolis (US) city center. Interviews identified how shared and multigenerational spaces to gather and access services/amenities helped buffer against perceived loneliness.

Social Isolation.

Five studies linked neighborhood built environments to social isolation. Wu and Chan’s (2011) Singapore study found that neighborhood availability of social care, support services, and public spaces for social interaction were associated with decreased odds of feeling isolated. Among residents in a high-crime California (USA) neighborhood, Portacolone et al.’s (2018) participants were often isolated because physical decay of buildings and streets, lack of safe and accessible benches and community rooms, and scarcity of health care and social services did not support social interactions. Taylor et al. (2023) found among US Black older adults that greater neighborhood physical disorder was associated with less social isolation from friends. The authors suggested that neighborhoods with greater physical disorder may be associated with greater population density, and older Black Americans in neighborhoods with high disorder may also have tight-knit communities and strong bonds between neighbors and friends.

Several studies investigated both isolation and loneliness. Menec et al. (2019), for example, found significant associations between some geographic factors and social isolation, but not loneliness, in Canada. Living in an urban core was related to increased odds of social isolation but became insignificant when controlling for area-level factors.

Broader Definitions of Social Health and Wellbeing.

Additional studies focused on social networks and ties (n = 3), social wellbeing (n = 2), social capital (n = 2), social inclusion (n = 1), and social support (n = 1). In a qualitative Gold Coast (Australia) study, Alidoust and Bosman (2015) highlighted the significant role of mixed-use social spaces to support strong (family/friend) and weak (acquaintance) social ties. Local third places such as churches, shopping centers, public libraries, and clubs had an important role in forming and maintaining social ties. Gardner’s (2011) Toronto (Canada) study highlighted third places and also transitory zones (i.e., sidewalks, subway platforms, and building lobbies) as significant social sites. Cab drivers, transit employees, waiters, bank tellers, and checkout clerks formed the everyday “regulars” in the social lives of older people. A Singaporean study by Lane et al. (2020) affirmed the importance of mixed-use third places to social network size. Female respondents who lived in closer proximity to a wet market (spaces where people can mingle while purchasing or bargaining for fresh produce and household necessities) were more likely to have higher levels on the Lubben Social Network scale.

Discussion

Neighborhoods and healthy aging research is rapidly growing, interdisciplinary, and international. Studies primarily focused on independent-dwelling adults aged 65 and older, though multiple cohort studies began earlier in late midlife (e.g., at age 51 in the US Health and Retirement Study). Most studies were quantitative (144 out of 168 total) and cross-sectional (n = 122). The literature encompassed a wide range of objective and subjective health outcomes significantly associated with neighborhood built environments.

Most reviewed studies considered neighborhood features in urban contexts, but others were explicitly rural or compared urban and rural environments. Neighborhoods were operationalized as multi-scalar and multidimensional constructs through a mix of objective and subjective measurement. Built environments ranged from micro to macro scales (e.g., benches to metro transit regions). We identified five overarching groupings of neighborhood features commonly assessed: (1) population density, land use mix, land cover, and rurality, (2) transportation and mobility infrastructure, (3) public parks, green/blue space, and open space, (4) access to services and amenities, and (5) order and safety.

Neighborhood Complexity

A notable challenge is capturing the complexity, fluidity, and multi-scalar aspects of neighborhoods. The multi-directional findings on “third places,” for example, demonstrate how neighborhood features can simultaneously promote and hinder health in later life. Fast-food restaurants constitute both spaces to gather and walkable destinations, as well as sites with foods high in salt, fat, and sugar. Parks may be located next to highways and other noxious land uses, which may offer opportunities for both health promotion (e.g., physical activity and peacefulness) as well as health risks (e.g., exposure to air, noise, and water pollution).

Neighborhood measurement is also difficult. The literature has evolved beyond administrative geographies (e.g., US census tracts) to better capture the scale of “neighborhood” that structures particular health outcomes. Participant-reported neighborhood characteristics were the most common assessment across studies. For objectively assessed studies, the scale of neighborhood measurement could change the results. In Finlay and colleagues’ (2020) first study, for example, access to eateries was positively associated with cognition when measured through a kernel density buffer. However, when eateries were measured at the census tract level (and other amenities/hazards simultaneously analyzed), they found a negative association with cognition (Finlay, Esposito, et al., 2022). The seemingly straightforward and intuitively lived concept of neighborhoods is extremely difficult to define and operationalize with unambiguous, meaningful, and consensual neighborhood boundaries (Galster, 2019).

The literature reviewed demonstrates that neighborhoods are not one-size-fits all. Axes of power and privilege including age, gender, race, ethnicity, education, income, and ability moderate the relationship between neighborhood built environments and health outcomes. For example, Araújo et al. (2018) and Namgung et al. (2019) found significant gender differences for obesity risk and neighborhood services, amenities, and aesthetics. De Keijzer et al. (2018) found the effect of neighborhood greenness and cognitive scores to be stronger among women than men, while Clarke et al. (2012) found an association for more neighborhood institutions and better cognitive health only among White participants. Disproportionately Black, Asian, and Hispanic/Latinx participants shared decreased neighborhood social activity since the pandemic onset given lack of public and private outdoor spaces to safely gather (Finlay, Esposito, et al., 2022). Bustamante et al. (2022) identified urban/rural differences in park access and mental health outcomes during the COVID-19 pandemic, with greater access to parks being associated with decreased anxiety and depressive symptoms for only urban participants.

More studies have begun to investigate potential mediating pathways between neighborhood environments and health outcomes with mixed results including physical activity and social integration and support. For example, Li et al. (2022) found that increased population density could reduce physical activity; while increased land mix use, shorter distance to transit, and a better visual rate of greenery, sky, and buildings in the environment could promote physical activity and lead to better self-rated health and subjective wellbeing among older adults. Zhang et al. (2021) found social networks to be a significant mediator for the association between transportation terminals and self-rated health.

Strengths and Limitations

A strength of this study is its assessment of over 168 articles to generate a state-of-the-field literature overview. Given the vast scope of later-life health outcomes, a systematic review was beyond the scope of this paper. Additionally, we reviewed English-only articles. This may skew our results towards Western contexts, though 74 articles were situated in Central and South America, Asia, and Africa. Our review criteria required publication between 2010 and 2022. As discussed earlier, pivotal neighborhood and aging studies published before 2010 form a foundation for this field and there may be relevant articles published after December 2022. Finally, we did not appraise the strengths and weaknesses of each study reviewed given the vast scope of the literature and heterogeneity of data collection, neighborhood measurement, health outcomes, and analytical approaches used across studies. Our review is intended to complement and stimulate more targeted systematic reviews.

Conclusions and Future Directions

The field is rapidly growing and evolving. As neighborhood contexts are multifaceted and fluid, there is a need for more nuanced methodological approaches. First, we recognize a challenge in the availability of and access to data that better describes the built environment. Future research should attempt to more holistically capture these complex, multifaceted, and longitudinal neighborhood measurements to better reflect the constellation of both positive and negative features experienced simultaneously. Second, there is a need for more longitudinal and mixed-methods studies. Most studies reviewed were cross-sectional and quantitative. This limits our understanding of temporality and how both exposure and outcomes could change over time. Additionally, more mixed-methods and qualitative studies could help improve our understanding of how and why specific neighborhood features shape health and wellbeing. Third, methods may need to purposefully change by population, particularly among older adults who may rely more on their immediate environments. Pleasant neighborhood views from a window, for example, may be an important factor among less mobile individuals (Finlay et al., 2015; Rowles, 1981). Furthermore, there is a need to apply social determinants of health lens to the neighborhood environments surrounding residential long-term care facilities.

The COVID-19 pandemic may have fundamentally changed neighborhood environments, health behaviors, and ways of aging in place. Finlay, Meltzer, et al. (2022) observed that the role of neighborhoods in later-life health has expanded since the pandemic onset because where older adults live even more critically impacts their abilities to be socially engaged, physically active, and feel safe and supported. It is essential to identify long-term impacts on the changeable and reciprocal relationship between older adults and their neighborhoods, such as shifts to online activities, temporary and permanent local business closures, and newfound anxiety in crowded spaces (Cannon et al., 2023). Future research may focus on the “new normal” of daily civic life anchored in neighborhoods and identify strategies and policies to bolster recovery and resilience in times of stress and instability.

Evidence-based investment in neighborhood infrastructure may boost health across the lifespan, reduce health disparities, and improve quality of later life. Increased knowledge translation efforts can apply this research into policy making and community interventions. Walkability provides a successful example of integrating neighborhoods-health research into urban planning efforts and broader public consciousness (e.g., with the accessibility and popularity of Walk Score^®). Public health officials and health care providers need to account for the evolving personal living situations and neighborhood environments of their constituents and patients. Such efforts can increase opportunities to connect vulnerable aging populations to essential resources and services and boost opportunities for healthy lifestyles, less stress, and reduced hazardous exposures. Research on specific neighborhood environmental features (as opposed to composite measures such as neighborhood socioeconomic status) can inform investment in more equitable neighborhood infrastructure. We can identify more specifically how neighborhoods are underserved. The built environment (e.g., the presence or absence of highways, parks, coffee shops, fast-food restaurants, and health services) physically expresses systemic racism and classism. These elements are more immediately actionable to address in policymaking, such as informing where to prioritize limited resources in built infrastructure projects. Including the perspectives of older adults themselves in the planning and delivery of community and public health interventions can support health and wellbeing among racially and socioeconomically diverse aging Americans.