Diverse contributions of multiple mediators to the impact of perceived neighborhood environment on the overall quality of life of community-dwelling seniors: A cross-sectional study in Nanjing, China

The worldwide population size of the elderly keeps rapid growth in recent years. Since older adults have a high preference to age in place, government should provide these community-dwelling seniors with enough essential support for successful aging. Owing to their functional impairment, the elderly's majority living environment outdoors shrinks to neighborhoods. Currently, government concentrates on the renewal of age-friendly neighborhood environment. As domains of quality of life (QoL), physical health (Phy-H), psychological health (Psy-H) and social relationship (SR) are proved to play important roles to affect the overall QoL of older adults. This study aims to explore diverse contributions of Phy-H, Psy-H and SR in influences of neighborhood environment on community-dwelling seniors' overall QoL. Phy-H, Psy-H and SR are assumed as multiple mediators between perceived neighborhood environment and the overall QoL. Based on data collected from seniors via questionnaire survey, the reliability test, multiple linear regression and multiple mediation effects test are adopted to identify and verify diverse functions of Phy-H, Psy-H and SR as multiple mediators. Multiple mediation models reveal that facilities related to physical exercise & recreation (PER-Fs) and accessibility to facilities influence community-dwelling seniors' overall QoL mainly through Psy-H and SR, while neighbor support mainly through only Psy-H. Results help to understand complicated relationships between neighborhood environment and the overall QoL of the elderly more deeply, then provide recommendations about efficient retrofits of neighborhood environment for the elderly by considering the multiple mediation effects.