2017 Theses Master's

The influence of the built environment on walking among urban, community-dwelling older adults in the United States: A systematic review and thematic synthesis

Winer, Emily

Background and Purpose: Driven by changing demographics, cultural shifts, and improvements in healthcare, the older adult population (≥65 years) in the United States (U.S.) is growing at a rapid and unprecedented rate. Simultaneously, the U.S, is becoming increasingly urbanized, with projections indicating that 87% of the U.S. population will live in urban centers by 2050. The convergence of an urbanizing and aging population necessitates a focus on aligning the urban environment with the needs of older adults. Among these needs is continued physical activity (PA) throughout older adulthood, yet despite the numerous physical, mental, and social benefits, the majority of older adults fail to meet recommended PA guidelines.
Objectives: To investigate the influence of the outdoor built environment on walking behaviors among urban, community-dwelling older adults (≥65 years) in the U.S. and to analyze results with reference to implications for designing and improving communities to support active living for this population.
Methods: A systematic review was conducted following PRISMA guidelines. Eight databases were searched for articles published 2011-2016 using search terms related to features of built environment, older adults, and walking. A total of 3254 abstracts were reviewed for eligibility, of which 17 studies fit all inclusion criteria. The final study set underwent quality appraisal, followed by data extraction, analysis, and thematic synthesis.
Results: Findings suggest that older adults engage in PA for two primary purposes, leisure or transport, and that unique aspects of the built environment support or act as a barrier to each type of walking. Macroscale components of walkability (e.g., land use mix, street connectivity, and population density) were consistently and positively associated with transport walking, whereas microscale elements, such as aesthetics, pedestrian infrastructure, and crossing characteristics, were more commonly associated with leisure walking.
Conclusions: Results support multiple associations between the built environment and walking behavior among older adults. This review furthers the current evidence regarding how macro and microscale features of the built environment can act upon older adults to support or discourage walking. While this area of research is growing, numerous gaps in the literature were identified. Future research is needed to improve the generalizability of findings to better inform future interventions and policies that support this population.