Date of Award
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Master of Public Health (MPH)
Department of Public Health Sciences
Dr. Amy Thierry
Dr. Kyler J. Sherman-Wilkins
Dr. Marcus Cox
Perceived Neighborhood Characteristics, Cognitive Function, Older Adults, Depression, Disparities, Racial Differences
Purpose: African American older adults have a greater risk of cognitive impairment compared to White older adults. While some research has established that neighborhoods are an important determinant of health, relatively little research has examined the relationship between perceived neighborhood characteristics and cognitive functioning among older adults. Moreover, little is known about how depression is implicated in the relationship between perceived neighborhood characteristics and cognitive functioning, and if racial differences exist. Thus, this thesis aims to determine the mediating and moderating role of depression in the association between perceived neighborhood characteristics and cognitive functioning in older African American and White adults.
Methods: I used data from the Health and Retirement Study and limited the sample to older Black and White adults age ≥65 years (n=7,620). Cognitive functioning was measured using the Telephone Interview for Cognitive Status (range: 0-35), with higher scores indicating better cognitive functioning. Depression was measured as a dichotomous variable using the Center for Epidemiologic Studies Depression Scale (CES-D). Depression scores ranged from 0 to 8 and the ≥3 cutoff was used to categorize adults with depression. Neighborhood perceptions of safety, cleanliness, and social cohesion were measured on a scale ranging from 0 to 7 with higher scores indicating worse perceptions. Linear regression models stratified by race were used to determine if depression played a mediating role in the relationship between perceived neighborhood characteristics (safety, social cohesion, and cleanliness) and cognitive functioning. The moderating role of depression was also examined using interaction terms with each neighborhood characteristic and depression.
Results: The results indicated that there is a negative relationship between perceived neighborhood characteristics and cognitive functioning among White older adults. Depression moderates the relationship between neighborhood characteristics (cleanliness, discohension) and cognitive functioning among White older adults. However, there was no moderating effect of depression among African American older adults. However, after controlling for neighborhood characteristics and other covariates, depression was associated with worse cognitive functioning.
Discussion/Conclusion: Depression is associated with worse cognitive functioning for both African American and White adults. Among White older adults with depression, there was a more pronounced negative association between neighborhood perceptions and cognitive functioning compared to those without depression. However, depression in African Americans was associated with worse cognitive functioning after controlling for neighborhood characteristics and other covariates. Therefore, depression is directly related to worse cognitive functioning in older adults.
Sullivan, MPH, Allison, "Perceived Neighborhood Characteristics and Cognitive Function among Older Adults: Examining the Role of Depression" (2021). Electronic Thesis and Dissertation. 49.