Longitudinal Individual, Social, and Contextual Determinants of Physical Functioning Trajectories: a Multi-site Study - PROJECT SUMMARY/ABSTRACT An unprecedented and increasing number of Americans are living to old age. As a result, the economic and societal benefits of maintaining physical function in older ages are significant and far-reaching. Importantly, while the prevalence of disabilities among older adults has been declining in recent decades, these declines have not extended to all segments of the population. Successful interventions to improve physical function and reduce disability for older Americans will require understanding and targeting contributing factors within highrisk groups across different regions of the US. Longitudinal, multi-site studies are necessary to identify the relative role of modifiable risk factors at the individual-level (e.g. lifestyle, social circumstances) and contextuallevel (e.g. neighborhood supports) across the life course across population subgroups. In this study, we propose to leverage over 30 years of extensive longitudinal data from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort to address major gaps in research on modifiable individual- and neighborhood-factors influencing differences in physical function as participants age. In addition to leveraging decades of data on individual lifestyle and social factors, we propose four complementary, large-scale data collection processes (i.e. GIS, virtual systematic audits, participant surveys, community-informant surveys) to expand neighborhood contextual data. Paired with performance-based objective physical function (i.e. Short Physical Performance Battery, SPPB) and self-reported physical function and disability, this study builds an unprecedented dataset that will enable us to understand and identify intervention strategies for maintaining physical function for all Americans and among high-risk groups in different regions of the US. This project is poised to provide robust new evidence links between individual life experiences, neighborhood environments, and physical function outcomes, with important implications for built environment science, disability research, and policies to support healthy aging. Aim 1 will better assess the role of individual modifiable factors (e.g. physical activity, sleep, substance use, mental health, social connection, work, stress) in functional decline within previously unexamined populations using longstanding lifestyle, behavior, and social data. Aim 2 will estimate the role of multifaceted, longitudinal neighborhood characteristics (e.g. in-home supports, walkability, access to resources, disorder, support for aging in place) to later life physical function and provide evidence to guide the design of neighborhood for healthy aging. Finally, in Aim 3 we combine these novel and rich datasets to investigate the relative contributions of these multi-level factors to differences in physical function outcomes among population subgroups. We anticipate this research will identify actionable community interventions to address and remediate aging inequalities derived from the unequal distribution of environmental supports for healthy aging. We expect this evidence to support and amplify efforts to effectively reduce age-related declines for all Americans.
