Neighbourhood Socioeconomic Status Shapes the Ageing Policy From an Ecological Perspective

Abstract

As global demographics shift towards an ageing population, the imperative to improve the health of older adults grows increasingly urgent. From the ecological perspective, neighbourhood characteristics play an important role in shaping health outcomes. Among these characteristics, socioeconomic status (SES) explains a large part of the variation in health status compared to other factors such as physical environment. To promote healthy ageing and improve overall well-being of older adults, it is necessary to focus on neighbourhood socioeconomic status (nSES). Currently, there is no clear and explicit definition for nSES. Previous studies referred nSES as neighbourhood deprivation, neighbourhood socioeconomic disadvantage, neighbourhood socioeconomic condition or position. Although a particular terminology has been favoured by different authors, it is generally thought to consist of similar concepts as individual socioeconomic status, but at a neighbourhood level.

Understanding the relationship between nSES and health outcomes can guide targeted interventions and ageing policies to reduce health disparities and create a supportive environment for healthy ageing. Therefore, the overall aim of this editorial is to discuss the impact of nSES on the health outcomes, so as to provide implications for the role of nurses in promoting healthy ageing.

Despite the increasing studies on nSES, the great variations in the methods to capture this condition in the research context were observed. Firstly, there is no agreement on the geographic scope of a neighbourhood. While the general definition of a neighbourhood was a proximate geographic area to an individual's residence, the specific geographic boundaries of a neighbourhood were still various. The selection of a geographic area usually depends on factors such as the research question, the outcomes being studied or feasibility considerations. Most studies employed administrative entities established by governments to define neighbourhoods, such as census tracts, block groups and postal codes. On the other hand, the indicators used to evaluate nSES were inconsistent across studies. Single indicator or composite index incorporating multiple indicators of neighbourhood characteristics were utilised to capture nSES. These indicators span various domains, including education, household income, wealth, employment, occupation, ethnicity, poverty rates, social security, marital status, housing-related factors and age demographics. Among these, education, household income, wealth and employment were commonly featured. Meanwhile, different approaches have been employed to identify indicators, including statistical analysis or predefined methods based on research evidence or expert opinion.

The lack of consensus on methods for capturing nSES hampers the comparability of research findings and complicates the ability to draw definitive conclusions and interpret the adverse health effects associated with nSES. Additionally, many studies fail to justify their selection of geographic areas and nSES indicators. This lack of clarity and transparency in research design renders it challenging to integrate the research findings. As the World Health Organization defines optimal healthy ageing is the represented by the high compatibility of the environment and intrinsic capacity of older adult, there is a pressing need to standardise the conceptual and operational definition of nSES. With the increasing evidence on the health impact of nSES in the past decade, it is timely to make critical analysis of such work so as to identify the operationalisation of nSES that can best explain various healthy ageing parameters.

Neighbourhood socioeconomic status plays a pivotal role in shaping healthy ageing by impacting a range of health outcomes. Extensive research has shown that low nSES is linked to heightened risks of all-cause mortality as well as disease-specific mortality (Xiao et al. 2018), disability (Tan, Zhang, and Ren 2024), impaired cognitive (Rosso et al. 2016) and psychological function (Everson-Rose et al. 2011). Consequently, individuals residing in low nSES neighbourhoods experienced more pronounced declines in health-related quality of life and increased utilisation of healthcare services, leading to higher healthcare costs (Schousboe et al. 2024). This body of evidence underscores the multifaceted impact of nSES on health outcomes. To promote healthy ageing, targeted and comprehensive interventions must be devised to address socioeconomic disparities at the neighbourhood level. However, the lack of evidence regarding the crucial features of nSES that influence health outcomes and the underlying mechanisms linking nSES to health impedes intervention development. Future research should focus on identifying key nSES characteristics influencing health outcomes and exploring potential mechanisms to enhance our understanding of how nSES impacts health outcomes.

The profound influence of nSES on health outcomes underscores the important role of nurses as key stakeholders in the healthcare system. In light of this, it is important for nurses to actively engage and advocate for initiatives that foster healthy ageing in the face of neighbourhood socioeconomic disparities.

Nurses promoting healthy ageing can expand their role to conduct comprehensive neighbourhood socioeconomic assessments and to incorporate such information in more integrative care planning. Seeking collaboration with an interdisciplinary team including professionals in public health, sociology, social work, geography and economical science are crucial to work out the scope and synergism of nSES indicators. Through the transdisciplinary assessments, nurses can identify the needy group who are disadvantaged by the nSES in attaining healthy ageing. Efforts should be placed on reducing neighbourhood health disparities by exploring how nSES interacts with the individual's health profile and social resource for more integrative care prescription and planning. Whereas the integrated care for older people emphasis on the six domain function including physical, cognitive, psychological, vitality, hearing and visual, the care planning should emphasis on how to optimise the social resource, support network and individual self-care capabilities in optimising these function. Strategies to foster social connections within the neighbourhood and access to healthcare service are also imperative.

Additionally, nurses can make valuable contributions to research endeavours aimed at enhancing understanding of the influence of nSES on healthy ageing. While existing studies highlighted the effects of nSES on health outcomes, there remain several research gaps that warrant attention. First, the obscene of a standardised tool for assessing nSES poses a challenge in accurately measuring and comparing neighbourhood deprivation levels across different studies. Second, there is a lack of clear evidence indicating which specific feature of nSES hold the greatest significance in shaping health outcomes. Third, the underlying mechanisms between nSES and health outcomes remain insufficiently explored. By actively engaging in research initiatives that address these gaps, nurses can advance the knowledge of the relationship between nSES and healthy ageing, ultimately informing more effective interventions and strategies to promote health equity and well-being in older adults.

Moreover, nurses can play an important role in advocating for policies and programs aimed at addressing low nSES to facilitate healthy ageing. Leveraging their expertise and experience, nurses can raise awareness of governmental entities and policymakers regarding the influence of nSES on health outcomes. By providing informed recommendations, nurses can contribute valuable insights to the development of policies targeting the reduction of nSES disparities. Moreover, nurses can actively participate in the implementation of these policies. Through their advocacy endeavours, nurses can significantly contribute to the establishment of a more equitable and inclusive neighbourhood environment, ensuring that every individual has the opportunity to age in good health and prosper.

Neighbourhood socioeconomic indicators serves as a critical factor influencing health outcomes, resulting in significant financial burdens. In order to effectively address this challenge and promote healthy ageing, nurses can take proactive measures, such as conducting comprehensive neighbourhood assessments, empowering older adults through education and support, actively participating in research initiatives and advocating for policies.

Conceptualization: Doris Y, Jing X. Writing: Jing X (Original draft), Doris Yu (review, revise and final editing).

This is an editorial study, so ethics statement is not needed.

The authors declare no conflicts of interest.