Neighborhood environment and cognitive function in older adults: A multilevel analysis in Hong Kong

In considering the influence of the neighborhood environment on cognitive function, little research has looked beyond the individual factors. Here, we conducted a study on 21,008 older adults aged 65 years and above in Hong Kong to examine the cross-sectional associations of neighborhood economic disadvantage, recreational resources, walkability, library accessibility and physical activities on cognitive function and dementia. Both smaller and larger census tracts were adopted as proxies for neighborhoods. Using multilevel regression, neighborhood economic disadvantage was found to be associated with cognitive decline, net of individual features. This association was not explained by neighborhood built environment. Recreational environment was not a significant factor for older adults' cognitive function while library accessibility was. Neighborhood walkability was only related to dementia but not the cognitive function score. Physical activity can partly explain the relationship between neighborhood environment and cognitive function. No significant interaction effect was identified except on the educational level and neighborhood library accessibility. To conclude, late life residential environments are important contexts for aging. Aging-in-place interventions in Hong Kong should thus address neighborhood poverty, improve accessibility of libraries and walkability to reduce future risks of cognitive decline.