Neighborhood Context and the Health of Older Adults

说明(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为突出；他们的日常活动可能取决于其社区的基础设施和社会资源，特别是在健康已经受到损害的情况下。虽然人们长期以来一直认为，一个人所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社会学新概念--集体效能，来研究社区和老年人的健康。使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、住院和地理编码医疗服务数据，我们问：1)是城市社区的结构性特征--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的健康状况相关吗？2)社区的社会过程--集体效能、社会网络、社会规范和身体/社会紊乱与老年居民的健康相关吗？3)社区的卫生服务基础设施是否与老年居民的健康相关？4)老年居民的健康是否影响社区维持社会网络和发展集体效能的能力？这个项目在四个方面超越了当前的研究。首先，通过使用多层次统计工具探索理论上知情的机制，扩展了现有关于社区背景与老年人健康的研究。其次，它纳入了邻里效应文献中一个研究不足的领域--卫生服务的作用和获得护理的机会。同时检查社区环境和卫生服务的影响可以增强我们对个人水平、种族/民族和社会经济差异在卫生方面的理解。第三，它承认邻里关系和健康之间既是互惠的，也是动态的。第四，它提供了一个独特的机会来审查多个层面的相互作用(例如，个人-邻里、邻里-卫生服务基础设施)。这个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，解决对这两个领域和与老龄化相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.