title: How safe is your neighborhood? Perceived neighborhood safety and functional decline in older adults.
abstract: BACKGROUND
  Neighborhood characteristics are associated with health and the perception of safety is particularly important to exercise and health among older adults. Little is known about the relationship between perception of neighborhood safety and functional decline in older adults.
  
  
  OBJECTIVE
  To determine the relationship between perceived neighborhood safety and functional decline in older adults.
  
  
  METHODS
  Longitudinal, community-based.
  
  
  METHODS
  18,043 persons, 50 years or older, who participated in the 1998 and 2008 Health and Retirement Study.
  
  
  METHODS
  The primary outcome was 10-year functional decline (new difficulty or dependence in any Activity of Daily Living, new mobility difficulty, and/or death). The primary predictor was perceived neighborhood safety categorized into three groups: "very safe", "moderately safe", and "unsafe." We evaluated the association between perceived neighborhood safety and 10-year functional decline using a modified Poisson regression to generate unadjusted and adjusted relative risks (ARR).
  
  
  RESULTS
  At baseline 11,742 (68.0%) participants perceived their neighborhood to be very safe, 4,477 (23.3%) moderately safe, and 1,824 (8.7%) unsafe. Over 10 years, 10,338 (53.9%) participants experienced functional decline, including 6,266 (50.2%) who had perceived their neighborhood to be very safe, 2,839 (61.2%) moderately safe, and 1,233 (63.6%) unsafe, P < 0.001. For the 11,496 (63.3%) of participants who were functionally independent at baseline, perceived neighborhood safety was associated with 10-year functional decline (moderately safe ARR 1.15 95% CI 1.09-1.20; unsafe ARR 1.21 95% CI: 1.03-1.31 compared to very safe group). The relationship between perceived neighborhood safety and 10-year functional decline was not statistically significant for participants who had baseline functional impairment.
  
  
  CONCLUSIONS
  Asking older adults about their perceived neighborhood safety may provide important information about their risk of future functional decline. These findings also suggest that future studies might focus on assessing whether interventions that promote physical activity while addressing safety concerns help reduce functional decline in older adults.
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Vivien K
authors.initials: VK
authors.lastname: Sun
authors.forename: Irena
authors.initials: I
authors.lastname: Stijacic Cenzer
authors.forename: Helen
authors.initials: H
authors.lastname: Kao
authors.forename: Cyrus
authors.initials: C
authors.lastname: Ahalt
authors.forename: Brie A
authors.initials: BA
authors.lastname: Williams
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D054624:Health Status Disparities; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010465:Perception; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012449:Safety; D011795:Surveys and Questionnaires