Perceived and objective neighborhood environment attributes and health related quality of life among the elderly in Bogotá, Colombia
Introduction
The world population is aging at a rapid pace. In 2006, nearly 500 million people worldwide were 65 years and older (Lunenfeld, 2008). The fastest growth in older adult populations is occurring in low and middle income regions such as Latin America, where between the years 2006 and 2030, the number of older adults is projected to rise by 140%, as compared to 51% in developed countries (Gavazzi, Herrmann, & Krause, 2004). Along with these trends, non-communicable diseases have become a public health challenge as they are now the leading cause of death among the older adult population worldwide (Lopez, Mathers, Ezzati, Jamison, & Murray, 2006). In Colombia, the reduction in fertility rates and the increase in life expectancy will lead to a reduction in the population 15 years and younger and an increase in the population 60 years and older, which is projected to grow from 9.6% in 2005 to 35.8% in 2020 (Lunenfeld, 2008). This demographic transition suggests the need to adjust policies and programs to facilitate healthy aging. In this sense, research that provides evidence of the individual and social determinants of health among the older adult population is warranted.
During the past decade, there has been increased interest in determining the relationship between objective and perceived environmental attributes and several behaviors and health outcomes such as physical activity (Dawson et al., 2007, Li et al., 2005, Nagel et al., 2008), obesity (Michael & Yen, 2009), disablement process (Clarke et al., 2008, Clarke and George, 2005), longevity (Takano, Nakamura, & Watanabe, 2002), SRH and quality of life (Wen, Hawkley, & Cacioppo, 2006), among the older adult population. Most of this evidence has been collected in high-income countries and little is known about the relationship between the built environment and quality of life among older adult populations from Latin America. To date, the only published study to explore the links between the built environment and quality of life in the region was conducted in Bogotá in 2005, among adults aged 18–65 years. The study explored particular associations between the neighborhood built environment and physical activity levels and HRQOL among the adult population of Bogotá (Cervero et al., 2009, Sarmiento et al., 2007). Despite this preliminary evidence, it is necessary to assess if such relationships are maintained or how they are different among the older population of Bogotá, as this population group may be more susceptible to changes in the urban environment.
Evidence supporting the association between both objective and perceived environmental characteristics and HRQOL among the older adult population is limited; however, there are plausible mechanisms for this association (O'Campo & O'Brien Caughy, 2006). Specifically, previous studies have associated access to public parks with promotion of wellbeing, social interaction and active recreation which can in turn influence quality of life (Kaczynski et al., 2008, Sallis et al., 2006). In addition, a study conducted by Takano (2002) found that more walkable green space had a positive influence on older adults' longevity, after controlling for individual risk factors. Likewise, perceived environmental characteristics, including noise and safety, could also influence HRQOL. In particular, noise pollution could affect quality of life, through the interference with sleep and other vital tasks. Vehicular congestion has also been recognized as an important deterrent of quality of life because of its association with noise and high prevalence of traffic accidents (Balfour and Kaplan, 2002, Fried and Barron, 2005). Unsafe environments, including those with high prevalence of crime, could be associated with high levels of environmental, physical and mental stress that can affect quality of life and mental health (Balfour and Kaplan, 2002, Bazargan, 1994, Fried and Barron, 2005).
Bogotá is the capital and largest urban settlement of Colombia, with a population of over seven million inhabitants (DANE, 2005). In addition, Bogotá is a very densely populated city with approximately 3912 inhabitants per square kilometer (Cetina, 2008). According to the last Colombian population census conducted in 2005, 9.6% of the population of Bogotá, is 60 years and older. It is projected that between 2005 and 2020 life expectancy in Bogotá will increase from 77.1 to 78.9 years (Kinsella, 1995). Contrary to what has happened in higher income countries; the urban development of the majority of Latin-American cities such as Bogotá has been characterized by its informality and a lack of urban planning. The process of population growth has been so rapid that there has not been sufficient time to plan and build appropriate urban infrastructure (Camargo, 2005, Cerrutti and Bertoncello, 2003).
During recent decades, Bogotá has engaged in important urban and social transformations, such as the implementation of new motorized and non-motorized transportation systems, investments in recreational facilities and public parks, and recovering of public space. These transformations might influence physical activity (Parra et al., 2007), and potentially health related quality of life (HRQOL) of older adults. Despite advances of the rapid bus transit system (Transmilenio), the public transportation system continues to have important deficiencies. Additionally, the city has a shortage of 43 million square meters of public space, with just over 4 square meters of green space per inhabitant (Cetina, 2008), falling well below the international standards of public space recommended for quality of life by the United Nations Habitat of 10 square meters per inhabitant (Gebre-Egziabher, 2004).
The aim of this study was to examine the associations between some objective and perceived environmental attributes on physical and mental HRQOL in a rapidly urbanized city in Latin America, such as Bogotá.
Section snippets
Study design
This study was conducted in 2007 and used a cross sectional multilevel design with 1966 older adults nested in 50 residential areas. For this study, neighborhood was defined as a small geographic area (mean area 102,377 m2, median area 80,277 m2, SD 98,751, mean population 4211) of similar social economic status (SES) at the household level, similar physical and urban attributes, and delimited by urban or natural barriers. An architect expert in urban design identified the neighborhoods using
Results
The study population was predominantly female (62.5%), with the majority of the population in the 64–70 age group (69.5%). Sixty six percent of the sample had an education level of elementary school or less. About sixty-two percent of the population reported 150 min or more of walking during the previous week. Other descriptive characteristics of the sample are presented in Table 1, Table 2.
Discussion
This study found significant associations between some perceived and objective environmental characteristics and HRQOL and SRH among older adults in Bogotá. Perceived environment characteristics such as street noise, safety of public areas and street crossings were found to be significantly associated with HRQOL. Density of public parks was the only objective environment characteristic associated with SRH. This is the first study of its kind to include older adult populations, carried out in a
Acknowledgments
This study was supported by a grant from the Colombian National Science Institute (COLCIENCIAS). The authors would like to thank Diego Ivan Lucumí Cuesta, Mauricio Ardila, Jose David Pinzon and Michael Pratt for their valuable comments and insights in earlier drafts of this manuscript and their participation as researchers and advisors of the study. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for
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