Manhattan, Westchester or the Hudson Valley?
Where you call home could have a real impact on whether you’ll die of dementia, according to new research.
“This is really a wakeup call,” Dr. Liron Sinvani told The Post. “This study really puts numbers behind what many of us in geriatrics have long suspected: The neighborhood you age in shapes how well you age.”
If you love the country or the big city, you’re in luck — dementia mortality drops in these categories, according to the study, published today in JAMA Network Open.
Researchers found the most dementia mortality was associated with neighborhoods that are somewhere in the middle.
Dementia, or decline in thinking or memory, is a symptom of other, often fatal diseases, like Alzheimer’s. This kills cells and spreads, inhibiting critical functions like heart rate and breathing.
“Most people assume that the highest risk for dementia would be in the most polluted, overcrowded cities or really isolated rural communities where there’s not much social interaction,” said Sinvani, a director of research and innovation at the Northwell Institute for Healthy Aging and professor of medicine at the Feinstein Institutes for Medical Research. “But this study flips that assumption on its head.”
Does that mean suburbs are the worst for dementia mortality? Kind of.
Researchers in the UK found the highest mortality in areas that had 20-40 people per hectare. In freedom units, that’s 5,000-10,000 people per square mile — which in the US are cities, but are still car-centric.
Some examples include the outer edges of Los Angeles city, Minneapolis, Baltimore, Pittsburgh and Milwaukee.
Sprawling cities like Atlanta and Phoenix are less dense and fall outside the danger zone indicated in the research. Bigger cities like Chicago, Boston, San Francisco and Manhattan in NYC would blow past the 10,000 per square mile number.
Obviously, the densest cities and the most rural areas couldn’t be more different. Though both of them have weak associations with dementia mortality, it’s for different reasons, Sinvani explained.
Cities offer services like doctor’s offices, pharmacies, groceries and public transport. And rural areas have cleaner air and better opportunities for being out in nature and keeping active.
“The suburbs get caught in a worst of both worlds situation,” Sinvani said. “They have many of the environmental downsides of urban living, like air pollution from traffic, but without the same level of walkable access to doctors and services that the city provides.”
Without easy access to the doctor, older folks might miss appointments, have delayed diagnoses, or get less consistent care. And without good air quality or opportunities for walking, they become less physically active and more socially isolated.
“Both of these are established risk factors for cognitive decline,” she said.
There is good news: Public health changes can make a big difference. Making more primary care offices available within walking distance, making more public transport options available, making routes safer to walk, “could literally save tens of thousands of lives,” she said.
Researchers estimated more than 65,000 dementia deaths could be avoided over a decade if modest service accessibility or outdoor environment improvements could be made.
Dementia takes the biggest toll in underserved populations, she adds, and where those communities live have the most to gain from these changes. “Targeted investment in some of these underserved socioeconomic communities could really be a life-or-death situation.”
None of us can change the layout of our town on our own, and often we can’t uproot our lives in old age. But there are still things older folks can do when living in this “missing middle” environment.
She suggests making it a priority to make doctor’s appointments, using family, friends, and public transport to get there. Find a park to get steps in, too.
“What is really encouraging about this study is that factors driving this increased risk are not fixed, they’re modifiable. We can actually change these risk factors. We are not talking about genetics or age,” Sinvani said.
