Neighborhood Context and the Health of Older Adults

描述（由申请人提供）：社区支持和维持居民个人福祉的能力对老年人来说尤其突出;他们的日常活动可能依赖于社区的基础设施和社会资源，特别是如果健康已经受到损害。虽然人们长期以来一直认为，一个人居住的社区会影响一个人的健康，但很难描述为什么，以及在什么情况下，社区环境有助于健康。我们带来了一个重要的新的社会学概念，集体效能，承担邻里和老年人健康的研究。利用芝加哥社区人类发展项目-社区调查、大都会社区信息中心-地铁调查、医疗保险索赔以及门诊、住院和地理编码的卫生服务数据，我们提出：1）城市社区的结构特征--集中贫困， 集中富裕、居住稳定性、种族异质性和年龄结构与老年居民健康状况的关系？2)邻里社会过程--集体效能、社交网络、社会规范和身体/社会失调与老年居民的健康有关吗？3)社区的卫生服务基础设施是否与老年居民的健康有关？老年居民的健康是否影响社区维持社交网络和发展集体效能的能力？该项目在四个方面超越了当前的研究。首先，它扩展了现有的研究邻里环境和老年人的健康探索理论上知情的机制与多层次的统计工具。其次，它纳入了一个在邻里效应文献中研究不足的领域--卫生服务的作用和获得保健的机会。同时研究邻里环境和卫生服务的影响，可以提高我们对个人层面的种族/民族和社会经济健康差异的理解。第三，它承认邻里关系和健康之间的关系是相互的和动态的。第四，它提供了一个独特的机会来检查跨多个层次的互动（例如，个人-邻里、邻里-卫生服务基础设施）。该项目结合了社会学和卫生服务研究的观点;它将这些学科联系起来，制定研究，解决对两个领域和与老龄化有关的政策至关重要的一系列问题。

DESCRIPTION (provided by applicant): The capacity of communities to bolster and sustain the well being of individual residents is particularly salient for older adults; their daily activities are likely dependent on the infrastructure and social resources of their communities, particularly if health is already compromised. Although it has long been believed that the neighborhood one lives in affects one's health, it has been difficult to delineate why, and under what circumstances, neighborhood context contributes to health. We bring an important new sociological concept, collective efficacy, to bear on the study of neighborhood and the health of older persons. Using data from the Project on Human Development in Chicago Neighborhoods-Community Survey, the Metropolitan Community Information Center-Metro Survey, Medicare Claims, and out-patient, hospitalization, and geocoded health services data, we ask: 1) Are structural features of urban neighborhoods--concentrated poverty, concentrated affluence, residential stability, ethnic heterogeneity, and age structurel associated with the health status of older residents?; 2) Are neighborhood social processes--collective efficacy, social networks, social norms, and physical/social disorder associated with the health of older residents?; 3) is the health services infrastructure of the neighborhood associated with the health of older residents?; and 4) Does the health of older residents affect the ability of the community to sustain social networks and develop collective efficacy? This project goes beyond current research in four ways. First, it extends existing research on neighborhood context and the health of older adults by exploring theoretically informed mechanisms with multi-level statistical tools. Second, it incorporates an understudied area in the neighborhood effects literature--the role of health services and access to care. Simultaneously examining the effects of neighborhood context and health services could enhance our understanding of individual-level racial/ethnic and socioeconomic disparities in health. Third, it acknowledges that the relationship between neighborhood and health is both reciprocal and dynamic. Fourth, it provides a unique opportunity to examine interactions across a number of levels (e.g., individual-neighborhood, neighborhood-health services infrastructure). This project combines perspectives from sociology and health services research; it bridges these disciplines to formulate research that addresses a set of questions vital to both fields and to aging-related policy.