JMIR Publications

ABSTRACT

Background:

Cognitive and physical frailty and polypharmacy in older adults are influenced by modifiable urban determinants, including built-environment attributes, access to services, and availability of green spaces.

Objective:

To examine the association between GIS-derived measures of urban quality and proximity to key urban resources and cognitive impairment, physical and cognitive frailty subtypes, and polypharmacy among older adults.

Methods:

We conducted a cross-sectional geospatial study including 317 adults aged ≥65 years from the PIEI-ES cohort residing in the urban area of Talca, Chile. Physical frailty was assessed using the Fried phenotype and cognitive impairment using an abbreviated Mini-Mental State Examination. Polypharmacy was defined as the daily use of ≥5 medications. Residential addresses were geocoded and linked to a GIS database of health services, community facilities, and main squares and parks. A summary index of urban quality was constructed from Euclidean distances to these resources and analyzed in quartiles and as a binary indicator using cutoffs of ≤18 and ≤16 points. Statistical analyses included t tests, Mann-Whitney, ANOVA, and logistic regression models.

Results:

Cognitive impairment was present in 25.2% (80/317) of the sample and was associated with older age (76.6 vs 72.5 years; P<.001) and higher frailty prevalence of frailty (66.3% vs 24.5%; P<.001). Polypharmacy affected 49.5% (157/317) and co-occurred with frailty (40.5% vs 28.1% among those without polypharmacy; P=.02). Urban quality index quartiles did not differ significantly by cognitive status or polypharmacy, and no clear gradient was observed across frailty subtypes or medication burden. Distance-based analyses showed that cognitively impaired individuals lived farther from main squares and parks (240.8 vs 211.1 m; P=.045) and closer to emergency health centers (688.7 vs 919.8 m; P=.02) than those without impairment. Older adults with polypharmacy and physically frail participants lived closer to primary and emergency health centers. In logistic models using the ≤18-point cutoff, low urban quality was not significantly associated with any outcome; using ≤16-point cut-off, it was associated with higher odds of polypharmacy (odds ratio 2.11, 95% CI 1.01–4.41).

Conclusions:

Cognitive impairment, frailty, and polypharmacy were highly prevalent and strongly interrelated, but their associations with the composite summary index of urban quality were modest. Cognitive vulnerability was linked to a greater distance from main squares and parks, whereas physically frail and polypharmacy groups tended to live closer to health centers. Urban quality may contribute more to patterns of medication burden than to frailty or cognitive impairment and should be considered alongside comprehensive geriatric assessment, rational prescribing, and age-friendly urban design in strategies to promote healthy aging.