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Gerontologist. 2013 Aug;53(4):641-53. doi: 10.1093/geront/gns118. Epub 2012 Oct 3.

Physical impairment is associated with nursing home admission for older adults in disadvantaged but not other neighborhoods: results from the UAB study of aging.

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  • 1Center for Outcomes and Effectiveness Research and Education, University of Alabama at Birmingham UAB, Birmingham, Alabama.



Aging adults face an increased risk of adverse health events as well as risk for a decrease in personal competencies across multiple domains. These factors may inhibit the ability of an older adult to age in place and may result in a nursing home admission (NHA). This study combines insights from Lawton's environmental press theory with the neighborhood disadvantage (ND) literature to examine the interaction of the neighborhood environment and individual characteristics on NHA.


Characteristics associated with the likelihood of NHA for community-dwelling older adults were examined using data collected for 8.5 years from the UAB Study of Aging. Logistic regression models were used to test direct effects of ND on NHA for all participants. The sample was then stratified into 3 tiers of ND to examine differences in individual-level factors by level of ND.


There was no direct link between living in a disadvantaged neighborhood environment and likelihood of NHA, but physical impairment was associated with NHA for older adults living highly disadvantaged neighborhood environments in contrast to older adults living in less disadvantaged neighborhood environments, where no association was observed.


These outcomes highlight (a) the usefulness of linking Lawton's theories of the environment with the ND literature to assess health-related outcomes and (b) the importance of neighborhood environment for older adults' ability to age in place.


Home- and community-based care and services; Long-term care; Neighborhoods; Sociology of aging/social gerontology; Theory

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