Currently submitted to: JMIR Aging
Date Submitted: Mar 21, 2025
Open Peer Review Period: Apr 2, 2025 - May 28, 2025
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Exploring the Influence of Urban Quality on Frailty, Nutritional Status, and Hematological/Biochemical Profile in Older Adults: Insights from Geospatial Approach
ABSTRACT
Background:
Urban environments influence frailty through factors related to infrastructure for physical activity, social and medical support, and access to quality nutrition. Given the increasing aging population, understanding the link between urban quality, frailty, and metabolic health is crucial for effective public health and urban planning interventions.
Objective:
To investigate the impact of urban quality on frailty and its correlation with nutritional status and hematological/biochemical parameters using geospatial analysis.
Methods:
A cohort of 251 older adults (aged 65+) was studied. Frailty was assessed using the Frailty Trait Scale 5 (FTS-5), and nutritional status was determined using the Controlling Nutritional Status (CONUT) score. Hematological and biochemical parameters were evaluated in a subset of 70 participants by MINDRAY automatic equipment. A spatial analysis of frailty was conducted by incorporating GIS layers that mapped the distribution of urban facilities, including fruit and vegetable shops, senior centers, pharmacies, emergency health centers, parks and squares, community centers, and sports fields. Statistical analyses included t-tests, Mann-Whitney, ANOVA, and correlation analyses.
Results:
The prevalence of frailty was 17.5%. Frail individuals exhibited significantly higher BMI (31.5 ± 4.4 vs. 28.5 ± 4.5 kg/m²; p=0.0001). When comparing the upper (Q4) and lower (Q1) quartiles of urban quality, Q4 participants had higher FTS-5 scores (15.2 ± 7.4 vs. 11.8 ± 6.4; p=0.0334) and lower handgrip strength (19.1 ± 4.4 vs. 22.8 ± 7.3 kg; p=0.0059). Frail individuals resided significantly closer to emergency health centers (p<0.0001), family health centers (p<0.05), and sports fields (p<0.05). Additionally, bilirubin (Spearman R=0.3325, p=0.0049), serum iron (Spearman R=0.272, p=0.0272), transferrin saturation (Spearman R=0.2478, p=0.0386), RBC (Spearman R=0.2629, p=0.0303), and RDW (Spearman R=0.2391, p=0.0462) were positively correlated with urban quality. Frail participants also had higher CONUT scores (p=0.0323), which were positive correlated with urban quality (Spearman R=0.2513, p=0.0359).
Conclusions:
Urban quality significantly influences hematological parameters, nutritional status, and frailty. Frail individuals in areas with better urban quality exhibit lower handgrip strength, higher frailty scores, and greater proximity to emergency rooms, community health centers, and sports fields. This suggests compensatory behaviour to address increased healthcare needs. Urban planning and public health strategies should focus on creating age-friendly environments to prevent frailty and improve health outcomes.
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