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Background: Due to societal changes and changes in the availability of health promoting factors, explanatory factors of socioeconomic inequalities in health (SIH) may change with time. We investigate differences in the relative importance of behavioural, social and psychological factors for explaining inequalities in physical performance between three birth cohorts. Methods: Data came from N = 988, N = 1002, and N = 1023 adults aged 55–64 years, collected in 1992, 2002 and 2012 as part of the Longitudinal Aging Study Amsterdam. Physical performance was measured by three performance tests. We included lifestyle factors (physical activity, smoking, alcohol use and Body Mass Index (BMI)); social factors (network size, network complexity, divorce, social support); and psychological factors (mastery, self-efficacy and neuroticism). In multi-group mediation models, we tested whether the strength of indirect effects from socioeconomic position (SEP) via the explanatory factors to health differed between birth cohorts. Stronger indirect effects indicate an increase in the importance; weaker indirect effects indicate a decrease in importance. Results: Absolute SIH were present and similar across cohorts. The strength of indirect effects of SEP on physical performance through smoking, binge alcohol use, emotional support and mastery increased across cohorts. The indirect effects of BMI, network size, self-efficacy and neuroticism were similar across cohorts. Conclusions: Inequalities in smoking, binge alcohol use, emotional support and mastery may have become more important for explaining SIH in recent cohorts of middle-aged adults. Policies that aim to reduce socioeconomic inequalities may need to adapt their targets of intervention to changing mechanisms in order to reduce SIH. [ABSTRACT FROM AUTHOR]

Background: Although the educational expansion is often seen as a mechanism that might reduce health inequalities, socioeconomic inequalities in health (SEIH) have persisted or increased over the past decades. Theories suggest that this persistence could be due to a changing role of education as a 'gatekeeper' to access other socioeconomic resources such as occupation and income that are also associated with health outcomes. To test this, we examine whether the mediating role of occupation and income in the education-health relationship differs between three cohorts of 55-64 year old adults.Methods: We used cross-sectional data from three cohorts of 988, 1002, and 1023 adults born in 1928/37, 1938/47 and 1948/57 and observed in 1992/93, 2002/03, 2012/13 respectively, who participated in the Longitudinal Aging Study Amsterdam, the Netherlands. We used multigroup structural equation modelling to compare the strength of indirect effects of education via occupational skill level and income to functional limitations and depressive symptoms between cohorts.Results: Absolute educational inequalities in functional limitations increased for men and women in later cohorts, and in depressive symptoms only for men. Relative inequalities in functional limitations increased only for women and in depressive symptoms only for men. The indirect effect of education via income on both health outcomes was weaker in the most recent birth cohort compared to the earlier cohorts. In contrast, the indirect effect of education via occupation on functional limitations was stronger in the most recent cohort compared to the earlier cohorts. These differences were mainly due to a decreasing direct effect of education on income and an increasing direct effect of education on occupational skill level, rather than to changes in the direct effects of occupation and income on health.Conclusions: The role of education in determining inequalities in health appears to have changed across cohorts. While education became a less important determinant of income, it became a more important determinant of occupational level. This changing role of education in producing health inequalities should be considered in research and policy. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Frailty, loneliness, and social isolation are all associated with adverse outcomes in older adults, but little is known about their combined impact on mortality. DESIGN: Prospective cohort study. SETTING: The Longitudinal Aging Study Amsterdam. PARTICIPANTS: Community‐dwelling older adults aged 65 and older (n = 1,427). MEASUREMENTS: Frailty was measured with the frailty phenotype (Fried criteria). Loneliness was assessed with the De Jong Gierveld Loneliness Scale. Social isolation was operationalized using information on partner status, social support, and network size. Two categorical variables were created, for each possible combination regarding frailty and loneliness (FL) and frailty and social isolation (FS), respectively. Mortality was monitored over a period of 22 years (1995–2017). Survival curves and Cox proportional hazard models were used to study the effects of the FL and FS combinations on mortality. Analyses were adjusted for sociodemographic factors, depression, chronic diseases, and smoking. RESULTS: Frailty prevalence was 13%, and 5.9% of the sample were frail and lonely, and 6.2% frail and socially isolated. In fully adjusted models, older adults who were only frail had a higher risk of mortality compared with people without any of the conditions (hazard ratio [HR] range = 1.40–1.48; P <.01). However, the highest risk of mortality was observed in people with a combined presence of frailty and loneliness or social isolation (HRFL = 1.83; 95% confidence interval [CI] = 1.42–2.37; HRFS = 1.77; 95% CI = 1.36–2.30). Sensitivity analyses using a frailty index based on the deficit accumulation approach instead of the frailty phenotype showed similar results, confirming the robustness of our findings. CONCLUSION: Frail older adults are at increased risk of mortality, but this risk is even higher for those who are also lonely or socially isolated. To optimize well‐being and health outcomes in physically frail older adults, targeted interventions focusing on both subjective and objective social vulnerability are needed. [ABSTRACT FROM AUTHOR]

Objectives Older immigrants are affected by an accumulation of adversities related to migration and aging. This study investigates resilience in older immigrants by examining the resources they use to deal with these adversities in the course of their lives. Methods Data from 23 life-story interviews with Turkish and Moroccan immigrants aged 60–69 years living in the Netherlands. Results The circumstances under which individuals foster resilience coincide with four postmigration life stages: settling into the host society, maintaining settlement, restructuring life postretirement, and increasing dependency. Resources that promote resilience include education in the country of origin, dealing with language barriers, having two incomes, making life meaningful, strong social and community networks, and the ability to sustain a transnational lifestyle traveling back and forth to the country of origin. More resilient individuals invest in actively improving their life conditions and are good at accepting conditions that cannot be changed. Discussion The study illustrates a link between conditions across life stages, migration, and resilience. Resilient immigrants are better able to accumulate financial and social and other resources across life stages, whereas less resilient immigrants lose access to resources in different life stages. [ABSTRACT FROM AUTHOR]

Background and Objectives The disability paradox postulates that some individuals with severe functional limitations demonstrate psychological resilience, that is, good mental health and quality of life. Resilience to disabilities has been linked to psychological (e.g., mastery) and social factors (e.g., social provisions). It is, however, less clear whether cultural factors can provide additional resources for resilience building in older immigrants. We investigated the extent to which sociodemographic, psychosocial, and cultural factors contributed to psychological resilience to disabilities among immigrants of Turkish and Moroccan descent in the Netherlands. Research Design and Method The sample included 478 older immigrants aged 55–65 years. Data were analyzed using latent profile analysis and multinomial logistic regressions. Results Five categories were identified: (a) High physical and emotional functioning; (b) High physical but poor emotional functioning; (c) Low physical but high emotional functioning (resilient); (d) Low physical and emotional functioning; and (e) Low physical and very low emotional functioning. Resilient functioning (reference category) was associated with poorer Dutch language proficiency, lower levels of loneliness, greater mastery, and more religious coping. Discussion and Implications Findings provide support for the disability paradox and highlight social provisions, mastery, and religiosity/spirituality as important resources for psychological resilience in older labor migrants. Poor Dutch language proficiency is discussed as a potential factor contributing to severe functional limitations in the resilient category. [ABSTRACT FROM AUTHOR]

Objectives: Despite a large body of sociological and psychological literature suggesting that religious activities may mitigate the effects of stress, few studies have investigated the beneficial effects of religious activities among immigrants. Immigrants in particular may stand to benefit from these activities because they often report a religious affiliation and often occupy disadvantaged positions. This study investigates whether private and public religious activities reduce the negative effects of a lack of physical, social, and socio-economic resources on wellbeing among Turkish and Moroccan young-old immigrants in the Netherlands. Method: Using data from the Longitudinal Study Amsterdam, cluster analysis revealed three patterns of absence of resources: physically disadvantaged, multiple disadvantages, and relatively advantaged. Linear regression analysis assessed associations between patterns of resources, religious activities and wellbeing. Results: Persons who are physically disadvantaged or have multiple disadvantages have a lower level of wellbeing compared to persons who are relatively advantaged. More engagement in private religious activities was associated with higher wellbeing. Among those with multiple disadvantages, however, more engagement in private religious activities was associated with lower wellbeing. Public religious activities were not associated with wellbeing in the disadvantaged group. Conclusion: Private religious activities are positively related to wellbeing among Turkish and Moroccan immigrants. In situations where resources are lacking, however, the relation between private religious activities and wellbeing is negative. The study's results highlight the importance of context, disadvantage and type of religious activity for wellbeing. [ABSTRACT FROM AUTHOR]

Background and Objectives This qualitative study applied a resilience perspective to socioeconomic inequalities in the functioning of older adults. We aimed to gain insight into how some older adults managed to age successfully despite having a low socioeconomic position (SEP) throughout their lives. Research Design and Methods Semistructured interviews were conducted with 11 resilient adults over the age of 79 years participating in the Longitudinal Aging Study Amsterdam, the Netherlands. Participants were defined as resilient on the basis of having a low lifetime SEP and favorable trajectories of physical, mental, and social functioning. Grounded Theory coding techniques were applied to identify themes reflecting distinct ways in which participants dealt with what they indicated were the most significant adversities in their lives. The analysis focused on experiences linked to socioeconomic conditions. Results Six themes reflecting psychological, behavioral, and social factors were derived from the data: drawing support from social contacts; investing in younger generations; taking actions to manage or improve socioeconomic conditions; putting the impact of a low SEP into perspective; persevering; and resigning oneself to adversity. Discussion and Implications Findings suggest that successful aging despite a low SEP throughout one’s lifetime requires considerable psychological and social resources. In addition, resignation and specific manifestations of generativity are identified as new elements of resilience. These findings may help to reduce the stereotyping of older adults with a low SEP, and nuance the heroic image of resilience as something that is primarily attributable to extraordinary individual abilities or efforts. [ABSTRACT FROM AUTHOR]

Background: Studying secular trends in the exposure to risk and protective factors of depression and whether these trends are associated with secular trends in the prevalence of depression is important to estimate future healthcare demands and to identify targets for prevention. Methods: Three birth cohorts of 55–64-year olds from the population-based Longitudinal Aging Study Amsterdam were examined using identical methods in 1992 (n = 944), 2002 (n = 964) and 2012 (n = 957). A two-stage screening design was used to identify subthreshold depression (SUBD) and major depressive disorder (MDD). Multinomial logistic regression analyses were used to identify secular trends in depression prevalence and to identify factors from the biopsychosocial domains of functioning that were associated with these trends. Results: Compared with 1992, MDD became more prevalent in 2002 (OR 1.90, 95% CI 1.10–3.28, p = 0.022) and 2012 (OR 1.80, 95% CI 1.03–3.14, p = 0.039). This was largely attributable to an increase in the prevalence of chronic diseases and functional limitations. Socioeconomic and psychosocial improvements, including an increase in labor market participation, social support and mastery, hampered MDD rates to rise more and were also associated with a 32% decline of SUBD-rates in 2012 as compared with 2002 (OR 0.68, 95% CI 0.48–0.96, p = 0.03). Conclusions: Among late middle-aged adults, there is a substantial net increase of MDD, which is associated with deteriorating physical health. If morbidity and disability continue to increase, a further expansion of MDD rates may be expected. Improving socioeconomic and psychosocial conditions may benefit public health, as these factors were protective against a higher prevalence of both MDD and SUBD. [ABSTRACT FROM AUTHOR]

Objective: To investigate socio-economic differences in changes in fruit and vegetable intake between 2004 and 2011 and explore the mediating role of financial barriers in this change.Design: Respondents completed a self-reported questionnaire in 2004 and 2011, including questions on fruit and vegetable intake (frequency per week), indicators of socio-economic position (education, income) and perceived financial barriers (fruits/vegetables are expensive, financial distress). Associations were analysed using ordinal logistic regression. The mediating role of financial barriers in the association between socio-economic position and change in fruit and vegetable intake was studied with the Baron and Kenny approach.Setting: Longitudinal GLOBE study.Subjects: A total of 2978 Dutch adults aged 25-75 years.Results: Respondents with the lowest income in 2004 were more likely to report a decrease in intake of cooked vegetables (P-trend<0·001) and raw vegetables (P-trend<0·001) between 2004 and 2011, compared with those with the highest income level. Respondents with the lowest education level in 2004 were more likely to report a decrease in intake of fruits (P-trend=0·021), cooked vegetables (P-trend=0·033), raw vegetables (P-trend<0·001) and fruit juice (P-trend=0·027) between 2004 and 2011, compared with those with the highest education level. Financial barriers partially mediated the association between income and education and the decrease in fruit and cooked vegetable intake between 2004 and 2011.Conclusions: These results show a widening of relative income and educational differences in fruit and vegetable intake between 2004 and 2011. Financial barriers explained a small part of this widening. [ABSTRACT FROM AUTHOR]

Objective: To investigate the factors that inhibit the disabling effect of impairments among citizens who have migrated from Turkey and Morocco and native Dutch according to a resilience perspective. Method: Using data from the Longitudinal Aging Study Amsterdam with 928 native Dutch, 255 Turks, and 199 Moroccans aged 55 to 65, linear regression analysis assessed whether country of origin, mastery, income, and contact frequency modified the relationship between gait speed and activity limitations. Results: Turks, but not Moroccans, demonstrated stronger associations between gait speed and activity limitations than the Dutch. Mastery modified the association among the Dutch and the Turks. Income modified the association only among the Dutch. Effect modification by contact frequency was not observed. Discussion: Moroccans and Dutch appeared to be more resilient against impairments than Turks. As none of the resilience factors buffered in all three populations, we conclude that resilience mechanisms are not universal across populations. [ABSTRACT FROM AUTHOR]

Objectives: Building on social stress theory, this study has 2 aims. First, we aim to estimate the effects of stressful life events in childhood and adulthood on Successful Aging (SA). Second, we examine how unequal exposure to such life events between individuals with different socioeconomic position (SEP) contributes to socioeconomic inequalities in SA. Method: We used 16-year longitudinal data from 2,185 respondents aged 55-85 years in 1992 in the Dutch nationally representative Longitudinal Aging Study Amsterdam. Measurement of SA was based on earlier work, in which we integrated trajectories in 9 indicators of functioning into an index of SA. Using path analysis, we investigated direct and indirect effects of parental and adulthood SEP as well as of self-reported childhood and adulthood life events on SA. Results: Almost all included life events had negative direct effects on SA. Parental SEP had no direct effect on SA, whereas adulthood SEP had. Higher Parental SEP increased the likelihood of parental problems and parental death in childhood, resulting in negative indirect effects on SA. Higher adulthood SEP had both positive and negative indirect effects on SA, through increasing the likelihood of divorce and unemployment, but decreasing the likelihood of occupational disability. Discussion: SEP and particular stressful life events are largely, but not entirely independent predictors of SA. We found that high and low SEP may increase exposure to particular events that negatively affect SA. Findings suggest that low (childhood) SEP and stressful life events are interrelated factors that may limit individual opportunities to age successfully. [ABSTRACT FROM AUTHOR]

Socioeconomic adversity is among the foremost fundamental causes of human suffering, and this is no less true in old age. Recent reports on socioeconomic inequalities in mortality rate in old age suggest that a low socioeconomic position continues to increase the risk of death even among the oldest old. We aimed to examine the evidence for socioeconomic mortality rate inequalities in old age, including information about associations with various indicators of socioeconomic position and for various geographic locations within the World Health Organization Region for Europe. The articles included in this review leave no doubt that inequalities in mortality rate by socioeconomic position persist into the oldest ages for both men and women in all countries for which information is available, although the relative risk measures observed were rarely higher than 2.00. Still, the available evidence base is heavily biased geographically, inasmuch as it is based largely on national studies from Nordic and Western European countries and local studies from urban areas in Southern Europe. This bias will hamper the design of European-wide policies to reduce inequalities in mortality rate. We call for a continuous update of the empiric evidence on socioeconomic inequalities in mortality rate. [ABSTRACT FROM PUBLISHER]

Objectives. Chronic diseases are important predictors of self-rated health (SRH). This study investigated whether multimorbidity has a synergistic or cumulative impact on SRH. Moderation by gender and age was examined. Methods. Data originated from the Longitudinal Aging Study Amsterdam (N = 2,046, aged 57–98 years). We assessed the presence of lung disease, cardiac disease, peripheral atherosclerosis, stroke, diabetes mellitus, arthritis, and cancer. SRH was measured with the question “How is your health in general?” including 5 response categories. Generalized ordered probit models were applied; possible synergism was examined by testing for nonlinearity of the association. Results. The association between multimorbidity and SRH was nonlinear in that the effect of having a single disease was larger than the added effects of co-occurring diseases. However, from the second disease onward, each additional co-occurring disease caused cumulative declines in SRH. Only in the oldest old (85+), the impact of a single disease was similar to that of co-occurring diseases. Results were similar for men and women. Discussion. Our findings help to improve understanding of the impact multimorbidity has on SRH: Having a single disease increases the chance of poor health more than each co-occurring disease, indicating some overlap between diseases or adaptation to declining health. [ABSTRACT FROM PUBLISHER]

The current study estimated the contribution of job characteristics to socioeconomic inequalities in incidence of myocardial infarction (MI) during a 12-year follow-up period. Data were from the working population (aged 25–64 years) in the Netherlands longitudinal GLOBE study (N =5757). Self-reported information was available from baseline measurement (in 1991) for education, occupation, job demand, job control, fear of becoming unemployed, adverse physical working conditions, and smoking and alcohol use. Information on hospital admissions for MI among study participants was available until 2003, and was linked to baseline data via record linkage. Cox regression analyses were performed to estimate the hazard of MI in different socioeconomic groups before and after adjustment for job characteristics and health-related behaviours. Lower educated and manual workers had a higher risk of MI during follow-up, after adjusting for age, sex and marital status than higher educated and non-manual workers, respectively. After adjustment for occupation, the lowest educated still had an elevated risk of MI. After adjustment for education, no significant association of occupation with MI was observed. Job control and adverse physical working conditions were not significantly associated with MI after adjustment for socioeconomic position. These results suggest that the reduction of the socioeconomic position–MI association after adjustment for the two specific job characteristics reflect the effect of other unobserved factors closely related to both socioeconomic position and job characteristics. The results of this study point toward education as being the stronger predictor of hospital admitted MI, compared to occupational position and job characteristics, in the Dutch working population. [Copyright &y& Elsevier]

Previous studies have shown that due to differences in the progression of the smoking epidemic European countries differ in the direction and size of socioeconomic variations in smoking prevalence. We studied differences in the direction and size of inequalities in lung cancer mortality by the educational level of subjects in 10 European populations during the 1990''s. We obtained longitudinal mortality data by cause of death, age, sex and educational level for 4 Northern European populations (England/Wales, Norway, Denmark, Finland), 3 continental European populations (Belgium, Switzerland, Austria), and 3 Southern European populations (Barcelona, Madrid, Turin). Age- and sex-specific mortality rates by educational level were calculated, as well as the age- and sex-specific mortality rate ratios. Patterns of educational inequalities in lung cancer mortality suggest that England/Wales, Norway, Denmark, Finland and Belgium are the farthest advanced in terms of the progression of the smoking epidemic: these populations have consistently higher lung cancer mortality rates among the less educated in all age-groups in men, including the oldest men, and in all age-groups in women up to those aged 60–69 years. Madrid appears to be less advanced, with less educated men in the oldest age-group and less educated women in all age-groups still benefiting from lower lung cancer mortality rates. Switzerland, Austria, Turin and Barcelona occupy intermediate positions. The lung cancer mortality data suggest that inequalities in smoking contribute substantially to the educational differences in total mortality among men in all populations, except Madrid. Among women, these contributions are probably substantial in the Northern European countries and in Belgium, but only small in Switzerland, Austria, Turin and Barcelona, and negative in Madrid. In many European countries, policies and interventions that reduce smoking in less educated groups should be one of the main priorities to tackle socioeconomic inequalities in mortality. In some countries, particularly in Southern Europe, it may not be too late to prevent women in less educated groups from taking up the smoking habit, thereby avoiding large inequalities in mortality in the future in these countries. [Copyright &y& Elsevier]

There is some evidence on socioeconomic inequality in morbidity among elderly people, but this evidence remains fragmentary. This study aims to give a comprehensive overview of educational and income inequalities in morbidity among the elderly of eleven European countries. Data from the first wave of 1994 of the European Community Household Panel were used. The study population comprised a total of 14,107 men and 17,243 women, divided into three age groups: 60–69, 70–79 and 80+. Three health indicators were used: self-assessed health, cut down in daily activities due to a physical or mental problem, and long-term disability. The results indicate that socioeconomic inequalities in morbidity by education and income exist among the elderly in Europe, in all the countries in this study and all age groups, including the oldest old. Inequalities decline with age among women, but not always among men. Greece, Ireland, Italy and The Netherlands most often show large inequalities among men, and Greece, Ireland and Spain do so among women. To conclude, inequalities in morbidity decrease with age, but a substantive part persists in old age. To improve the health of elderly people it is important that the material, social and cultural resources of the elderly are improved. [Copyright &y& Elsevier]

Poor health after retirement may have an important economic and societal impact and may be affected by macro-level factors. Our aim was to examine whether macro-level factors are associated with health and educational differences in health in recent retirees. We used data covering 18 European countries from the Survey on Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA) on 8867 respondents who had been retired less than 5 years. We performed multi-level linear regression analyses to examine whether social expenditure in nine policy areas, minimum pension replacement rates, and unemployment replacement rates explained cross-country differences in post-retirement self-rated health (SRH) and educational inequalities in SRH. In both men and women, a higher total expenditure as well as higher expenditures on health, old age, housing, and 'other social policy areas' (non-categorical cash benefits to low-income households and other social services) were associated with better SRH. Cross-level interactions showed that in the presence of a higher old age expenditure, a higher unemployment expenditure, and a higher total expenditure, the absolute educational inequalities in post-retirement SRH were smaller than with lower expenditures in these areas, in both men and women. We found the same effect in women only for a higher expenditure on health as well as a higher minimum pension replacement rate. A higher expenditure on survivors pensions, a lower expenditure on family, and a higher unemployment replacement rate had this effect in men only. This study showed that social expenditure and replacement rates were associated with post-retirement health and health inequalities. • Higher social spending was associated with better post-retirement health. • Educational health differences were smaller in countries with high social spending. • These effects were generally similar for women and men. [ABSTRACT FROM AUTHOR]

Abstract: Background and Objectives: Information on socioeconomic inequalities in incidence of and recovery from disability is still scarce, as is information on socioeconomic inequalities in performance-based disability as compared to self-reported disability. This study aimed to estimate educational inequalities in the prevalence, incidence, and recovery of self-reported and performance-based disability in two European populations. Study Design and Setting: We analyzed data from two longitudinal studies on aging. At each wave, participants were asked to what degree they experienced difficulty with several functional tasks, and interviewers rated their performance on several tasks. Educational inequalities in both outcomes were expressed in terms of prevalence, incidence, and recovery ratios. Results: Educational inequalities in both prevalence and incidence of disability were observed. No large educational inequalities in recovery from disability could be demonstrated. Compared to inequalities in self-reports of disability, inequalities in performance-based disability were equally large in the Dutch study, but smaller in the Italian study. Conclusions: Inequalities in performance-based measures of disability stress the importance of the association of socioeconomic position with disability among older populations. Our results suggest that higher education serves to postpone or avoid disability, but provides less benefit when disability is already present. [Copyright &y& Elsevier]

A growing literature suggests that neighbourhood characteristics are associated with mental health outcomes, but the evidence in older adults is inconsistent. We investigated the association of neighbourhood characteristics, pertaining to demographic, socio-economic, social and physical environment domains, with the subsequent 10-year incidence of depression and anxiety, in Dutch older adults. In the Longitudinal Aging Study Amsterdam depressive and anxiety symptoms were assessed four times between 2005/2006 and 2015/2016, using the Center for Epidemiological Studies Depression Scale (n = 1365) and the Anxiety subscale of the Hospital Anxiety and Depression Scale (n = 1420). Neighbourhood-level data on urban density, percent population over 65 years of age, percent immigrants, average house price, average income, percent low-income earners, social security beneficiaries, social cohesion, safety, proximity to retail facilities, housing quality, percent green space, percent water coverage, air pollution (particulate matter (PM2.5)), and traffic noise, were obtained for study baseline years 2005/2006. Cox proportional hazard regression models, clustered within neighbourhood, were used to estimate the association between each neighbourhood-level characteristic and the incidence of depression and anxiety. The incidence of depression and anxiety was 19.9 and 13.2 per 1000 person-years, respectively. Neighbourhood characteristics were not associated with the incidence of depression. However, various neighbourhood characteristics were associated with an increased incidence of anxiety, including: higher urban density level, higher percent immigrants, greater proximity to retail facilities, lower housing quality score, lower safety score, higher PM2.5 levels and less green space. Our results indicate that several neighbourhood characteristics are associated with anxiety but not with depression incidence in older age. Several of these characteristics have the potential to be modifiable and thus could serve as a target for interventions at the neighbourhood-level in improving anxiety, provided that future studies replicate our findings and provide further evidence for a causal effect. • Neighbourhood characteristics might impact mental health of older adults. • Incident depression was not associated with neighbourhood characteristics. • Several neighbourhood characteristics were associated with the onset of anxiety. [ABSTRACT FROM AUTHOR]

Positive associations of neighborhood socioeconomic characteristics and older adults' cognitive functioning have been demonstrated in previous studies, but overall results have been mixed and evidence from European countries and particularly the Netherlands is scarce. We investigated the effects of socioeconomic status (SES) and urbanity of neighborhoods on four domains of cognitive functioning in a sample of 985 Dutch older adults aged 65–88 years from the Longitudinal Aging Study Amsterdam. Besides cross-sectional level differences in general cognitive functioning, processing speed, problem solving and memory, we examined cognitive decline over a period of six years. Growth models in a multilevel framework were used to simultaneously assess levels and decline of cognitive functioning. In models not adjusting for individual SES, we found some evidence of higher levels of cognitive functioning in neighborhoods with a higher SES. In the same models, urbanity generally showed positive or inversely U-shaped associations with levels of cognitive functioning. Overall, effects of neighborhood urbanity remained significant when adjusting for individual SES. In contrast, level differences by neighborhood SES were largely explained by the respondents’ individual SES. This suggests that neighborhood SES does not influence levels of cognitive functioning beyond the fact that individuals with a similar SES tend to self-select into neighborhoods with a corresponding SES. No evidence of systematically faster decline in neighborhoods with lower SES or lower degrees of urbanity was found. The findings suggest that neighborhood SES has no independent effect on older adults cognitive functioning in the Netherlands. Furthermore, the study reveals that neighborhood urbanity should be considered a determinant of cognitive functioning. This finding is in line with theoretical approaches that assume beneficial effects of exposure to complex environments on cognitive functioning. We encourage further investigations into the effect of urbanity in other contexts before drawing firm conclusions. [ABSTRACT FROM AUTHOR]