Neighborhood social environment and physical activity among persons living with dementia

Physical activity (PA) helps delay the progression of cognitive and functional decline among persons living with dementia. Neighborhood social environments are well-known to support or hinder PA among older adults, but their associations with PA among persons living with dementia remain poorly understood. This study examines how neighborhood characteristics (affluence, deprivation, safety, friends, relatives, cohesion, and disorder) relate to PA among U.S. community-dwelling persons living with dementia.

We used 2006-2018 Health and Retirement Study data merged with census-tract data from the Contextual Data Resource. The analytic sample included 2,031 respondents classified as having dementia. PA was measured as a summary score reflecting activity frequency and intensity (light, moderate, and vigorous), along with binary indicators for being "regularly active" (≥1×/week) at each intensity. We used negative binomial regression to model total PA and logistic regression for intensity-specific activity.

Neighborhood friendships were associated with higher overall PA score (B = 0.28; 95% CI = 0.16-0.41) and regular engagement across intensity levels. Social cohesion was also linked to increased total activity (B = 0.16; 95% CI = 0.03-0.29) and light PA (OR = 1.31; 95% CI = 1.01-1.71). Affluent neighborhoods supported moderate PA (OR = 1.39; 95% CI = 1.08-1.77), while having nearby relatives was associated with lower odds of vigorous activity (OR = 0.61; 95% CI = 0.42-0.88). No significant associations were observed for neighborhood deprivation, disorder, or safety.

Our findings provide empirical evidence for the importance of neighborhood social resources as facilitators of sustained PA among persons living with dementia and highlight neighborhoods as key components of the continuum of dementia care.