Urban Social and Built Environments and Trajectories of Decline in Social Engagement in Vulnerable Elders: Findings From Detroit's Medicaid Home and Community-Based Waiver Population

There is little knowledge on the relationships between neighborhood environments and trajectories of social engagement among physically and economically vulnerable older adults. We examined the association between neighborhood social and built environments (physical disorder, the presence of crime watch signs, and street conditions) and 36-month trajectories of social engagement among 965 older adults living in Detroit, Michigan. Social withdrawal was defined as a decline in social engagement without distress while social isolation was defined as a decline in social engagement with distress. We utilized data from Michigan's Minimum Data Set for Home Care (2000-2008), merged with contextual data collected through a virtual audit instrument using Google Earth's Street View feature. Results from multilevel multinomial analyses indicated that the presence of neighborhood watch signs was associated with increased chance of social withdrawal and social isolation among frail older adults over time, highlighting the potential anxiety-provoking effect of precautionary measures against crime.