The association between perceived social and physical environment and mental health among older adults: mediating effects of loneliness

Abstract

Objectives: Despite growing interest in the impact of physical and social environment on mental health, data are lacking on the potential mediating effects of loneliness. We examined it in the association of several social and physical environmental characteristics with mental health among older adults in three municipalities in Flanders (Belgium).

Methods: A total of 869 people aged 60 and over were interviewed. Loneliness was assessed through the De Jong Gierveld short scales for emotional and social loneliness. Social participation and social cohesion were assessed following the Neighborhood scales whereas physical environment characteristics were selected from the Neighborhood Environment Walkability Scale. Mental health was assessed through subscale psychological frailty of the Comprehensive Frailty Assessment Instrument plus (CFAI-plus). Linear regression models, including mediation analysis, were used to analyze the survey data.

Results: After adjusting for individual characteristics, physical and social environment factors were significantly related to mental health with the significant mediation of emotional and social loneliness. Percentages mediated by both dimensions together were 61% for social cohesion, 43% for social participation, 35% for safety and 25% for mobility. Compared with social loneliness, emotional loneliness was a stronger mediating factor, particularly for mobility and safety. No significant associations between traffic density or basic service availability and mental health were found.

Discussion: Improving the social and physical environment might result in a reduction in the prevalence of loneliness and in consequent improvement of mental health among older adults. Special attention should be paid to different types of loneliness.

Keywords:

• Built environment
• social cohesion
• mental health
• loneliness
• older adults
• mediation analysis

Acknowledgements

We thank Tom Yohannan for help in English language editing.

Contributors

The study design was planned by JD-A, LS, JM, ED, SD and LDD. JD-A conducted the data analyses. JD-A and LS drafted the article. LDD supervised the data analyses and development of the paper. The paper was edited and reviewed by all the authors.

Disclosure statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Funding

The study is part of the research program ‘D-SCOPE: Detection, Support and Care of Older people: Prevention and Empowerment’ (http://www.dscope.be), which is supported by a grant from the Flemish government agency for Innovation by Science and Technology [IWT-140027 SBO]. This research is conducted independently of the funding body. Joan Domènech-Abella’s and Jordi Mundo’s work is supported by the PGC2018-094324-B-I00 research project, funded by the Ministry of Science, Innovation and Universities (MCIU), the State Research Agency (AEI) and the European Regional Development Fund (ERDF).