Association of the built environments and health-related quality of life in community-dwelling older adults: a cross-sectional study
Eight types of built environments at the township level were calculated, and 1222 nationally representative older adults aged 65 and older were recruited. The outcome variable was health-related QoL as measured using the EQ-5D, including utility score and the EQ-VAS. Statistical methods included descriptive analysis, bivariate analysis, and mixed-effects logistic regression analysis, which were conducted using SAS 9.4 software.
The results showed that a significant relationship exists between cultural and historical facilities and low EQ-VAS; none of the built environments were found to be related to the EQ-5D. Individual factors are the main determinants of the EQ-5D of older adults in Taiwan. Positive relationships were found if older adults were engaging in physical activities and social participation.
We suggest that building a supportive environment in which elderly people could consistently engage in physical activities and social participation is another potential approach that might contribute to active aging.
KeywordsBuilt environments Quality of life The elderly EQ-5D Multi-level analysis
We’d like to express our appreciation for the suggestions of the professors, researchers, and members of the Centre for Environment and Population Health, Griffith University.
This work was supported by the Ministry of Science and Technology, Taiwan (Grant Number: 106-2917-I-006-011) and a project of active aging from the Health Promotion Administration, Ministry of Health and Welfare, Taiwan (Grant Number: MOHW106-HPA-M-114-134709, MOHW107-HPA-M-114-144703).
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
This analysis was based on a dataset from the National Health Interview Survey. However, the interpretation and conclusions contained herein do not represent those of the Health Promotion Administration, Ministry of Health and Welfare, Taiwan. All procedures performed in this study were in accordance with the ethical standards of Institutional Review Board of National Cheng Kung University Hospital, by Human Study Approval (IRB No: B-ER-104-087).
- 1.WHO. (2015). World report on ageing and health. Geneva: World Health Organization.Google Scholar
- 2.WHO. (2000). Social development and ageing: Crisis or opportunity?. Geneva: World Health Organization.Google Scholar
- 5.Hooyman, N. R., & Kiyak, H. A. (2011). Social gerontology: A multidisciplinary perspective (9th ed.). Boston, MA: Allyn & Bacon.Google Scholar
- 12.Yu, S. T., Chang, H. Y., Yao, K. P., Lin, Y. H., & Hurng, B. S. (2015). Validity of EQ-5D in general population of Taiwan: Results of the 2009 National Health Interview and Drug Abuse Survey of Taiwan. Quality of Life Research, 24(10), 2541–2548. https://doi.org/10.1007/s11136-015-0978-7.CrossRefPubMedGoogle Scholar
- 14.Cerin, E., Nathan, A., van Cauwenberg, J., Barnett, D. W., Barnett, A., et al. (2017). The neighbourhood physical environment and active travel in older adults: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 15. https://doi.org/10.1186/s12966-017-0471-5.CrossRefPubMedGoogle Scholar
- 16.Parra, D. C., Gomez, L. F., Sarmiento, O. L., Buchner, D., Brownson, R., Schimd, T., et al. (2010). Perceived and objective neighborhood environment attributes and health related quality of life among the elderly in Bogota, Colombia. Social Science and Medicine, 70(7), 1070–1076. https://doi.org/10.1016/j.socscimed.2009.12.024.CrossRefPubMedGoogle Scholar
- 20.Barton, H., & Grant, M. (2006). A health map for the local human habitat. The Journal for the Royal Society for the Promotion of Health, 126(6), 252–253.Google Scholar
- 22.WHO. (2002). Active ageing: A policy framework. Geneva: World Health Organization.Google Scholar
- 25.Raggi, A., Corso, B., Minicuci, N., Quintas, R., Sattin, D., De Torres, L., et al. (2016). Determinants of quality of life in ageing populations: Results from a cross-sectional study in Finland. Poland and Spain. PLoS ONE, 11(7), e0159293. https://doi.org/10.1371/journal.pone.0159293.CrossRefPubMedGoogle Scholar
- 26.Cerin, E., Sit, C. H. P., Zhang, C. J. P., Barnett, A., Cheung, M. M. C., Lai, P.-C., et al. (2016). Neighbourhood environment, physical activity, quality of life and depressive symptoms in Hong Kong older adults: A protocol for an observational study. British Medical Journal Open, 6(1), 010384. https://doi.org/10.1136/bmjopen-2015-010384.CrossRefGoogle Scholar
- 27.Marventano, S., Prieto-Flores, M. E., Sanz-Barbero, B., Martín-García, S., Fernandez-Mayoralas, G., Rojo-Perez, F., et al. (2015). Quality of life in older people with dementia: A multilevel study of individual attributes and residential care center characteristics. Geriatrics & Gerontology International, 15(1), 104–110.CrossRefGoogle Scholar
- 31.WHO. (2009). Zagreb declaration for healthy cities: Health and equity in all local policies. Copenhagen: WHO regional Office for Europe.Google Scholar
- 35.Szanton, S. L., Thorpe, R. J., Boyd, C., Tanner, E. K., Leff, B., Agree, E., et al. (2011). Community aging in place, advancing better living for elders: A bio-behavioral-environmental intervention to improve function and health-related quality of life in disabled older adults. Journal of the American Geriatrics Society, 59(12), 2314–2320. https://doi.org/10.1111/j.1532-5415.2011.03698.x.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.National Development Council. (2018). Population Projections for Republic of China (Taiwan): 2018–2065. Taipei: National Development Council. Retrieved January 18, 2019, from https://www.ndc.gov.tw/en/cp.aspx?n=2E5DCB04C64512CC.
- 37.Huang, S. J. (2002). On Taiwan’s level of urbanization. Taiwanese Journal of Sociology, 27, 163–205.Google Scholar
- 38.National Development Council. (2017). Urban and Regional Development Statistics, Republic of China (Chinese version). Retrieved January 18, 2019, from https://ngis.nat.gov.tw/statistic/download.htm.
- 39.Reenen, M. V., Oppe, M., Boye, K. S., Herdman, M., Kennedy-Martin, M., Kennedy-Martin, T., et al. (2018). EQ-5D-3L User Guide: Basic information on how to use the EQ-5D-3L instrument (version 6) Rotterdam: EuroQol Research Foundation. Retrieved from https://euroqol.org/publications/user-guides.
- 40.Dolan, P. (1997). Modeling valuations for EuroQol health states. Medical Care: 1095–1108.Google Scholar
- 44.Huang, N. C., Kung, S. F., & Hu, S. C. (2018). The relationship between urbanization, the built environment, and physical activity among older adults in Taiwan. International Journal of Environmental Research and Public Health, 15(5), 836. https://doi.org/10.3390/ijerph15050836.CrossRefPubMedCentralGoogle Scholar
- 46.Hillsdon, M., Coombes, E., Griew, P., & Jones, A. (2015). An assessment of the relevance of the home neighbourhood for understanding environmental influences on physical activity: How far from home do people roam? International Journal of Behavioral Nutrition and Physical Activity, 12(1), 100. https://doi.org/10.1186/s12966-015-0260-y.CrossRefPubMedGoogle Scholar
- 49.Cauwenberg, J., Donder, L., Clarys, P., Bourdeaudhuij, I., Buffel, T., & Witte, N. (2014). Relationships between the perceived neighborhood social environment and walking for transportation among older adults. Social Science and Medicine, 104, 23–30. https://doi.org/10.1016/j.socscimed.2013.12.016.CrossRefPubMedGoogle Scholar
- 50.Rind, E., Shortt, N., Mitchell, R., Richardson, E. A., & Pearce, J. (2015). Are income-related differences in active travel associated with physical environmental characteristics? A multi-level ecological approach. International Journal of Behavioral Nutrition and Physical Activity, 12(1), 73. https://doi.org/10.1186/s12966-015-0217-1.CrossRefPubMedGoogle Scholar
- 51.Ene, M., Leighton, E. A., Blue, G. L., & Bell, B. A. (2015). Multilevel models for categorical data using SAS® PROC GLIMMIX: the basics. In SAS Global Forum 2015 Proceedings, 3430-2015.Google Scholar
- 52.Hair, J. F., Anderson, R. E., Babin, B. J., & Black, W. C. (2010). Multivariate data analysis, a global perspective (Vol. 7). New Jersey: Pearson.Google Scholar
- 53.Bruce, J. M., Echemendia, R. J., Meeuwisse, W., Hutchison, M. G., Aubry, M., & Comper, P. (2018). Development of a risk prediction model among professional hockey players with visible signs of concussion. British Journal of Sports Medicine, 52(17), 1143–1148. https://doi.org/10.1136/bjsports-2016-097091.CrossRefPubMedGoogle Scholar
- 58.Pasanen, T. P., Tyrväinen, L., & Korpela, K. M. (2014). The relationship between perceived health and physical activity indoors, outdoors in built environments, and outdoors in nature. Applied Psychology: Health and Well-Being, 6(3), 324–346. https://doi.org/10.1111/aphw.12031.CrossRefGoogle Scholar
- 59.Wen, M., Hawkley, L. C., & Cacioppo, J. T. (2006). Objective and perceived neighborhood environment, individual SES and psychosocial factors, and self-rated health: An analysis of older adults in Cook County. Illinois. Social Science & Medicine, 63(10), 2575–2590. https://doi.org/10.1016/j.socscimed.2006.06.025.CrossRefGoogle Scholar
- 60.Fu, Y. Y., Guo, Y., Bai, X., & Chui, E. W. T. (2017). Factors associated with older people’s long-term care needs: A case study adopting the expanded version of the Anderson Model in China. BMC Geriatrics, 17(1), 38. https://doi.org/10.1186/s12877-017-0436-1.CrossRefPubMedPubMedCentralGoogle Scholar
- 61.The Ministry of Health and Welfare. (2013). Senior Citizen Condition Survey. Retrieved January 18, 2019, from https://dep.mohw.gov.tw/dos/cp-1767-3586-113.html.
- 63.Ministry of the Interior. (2015). Urban Planning Law. Retrieved January 18, 2019, from https://law.moj.gov.tw/ENG/LawClass/LawAll.aspx?pcode=D0070001.
- 64.Insch, A., & Florek, M. (2010). Place satisfaction of city residents: Findings and implications for city branding. In G. Ashworth & M. Kavaratzis (Eds.), Towards effective place brand management: Branding European Cities and Regions (pp. 191–204). Cheltenham: Edward Elgar Publishing.Google Scholar