After diagnosis, place matters: the role of neighborhood built environment in aging in place among older adults with cognitive impairment

OBJECTIVES: As populations age, dementia is becoming increasingly prevalent, posing major public health challenges. Aging in place (AIP) is an important policy and personal objective for older adults, including those experiencing cognitive impairment. We investigated whether specific environmental features influence AIP of older adults with cognitive impairment and how cognitive impairments or dementia diagnoses affect caregivers' environmental perceptions and decision-making. METHODS: This convergent mixed-methods study surveyed 95 caregivers of older adults with cognitive impairment. Logistic regression was used to identify neighborhood features that predicted the AIP outcome, while thematic analysis examined caregivers' qualitative narratives on how neighborhood features shape AIP decisions. RESULTS: Neighborhood features had limited direct effects on the AIP outcome, regardless of dementia severity. However, a significant interaction emerged between formal diagnosis and perceived safety (p < .01). This indicates an important moderating role of diagnosis status, with each additional point on the safety scale associated with a 10% increase in the AIP odds among those with a formal dementia diagnosis. Qualitative findings reinforced the importance of perceived safety, while also highlighting accessible destinations/services and community support as additional facilitators of AIP. DISCUSSION: These findings suggest environmental features and diagnostic status jointly shape AIP decisions. A timely dementia diagnosis may heighten caregiver awareness of environmental supports and barriers, enabling informed adjustments. To create inclusive neighborhoods that support AIP, coordinated approaches integrating early diagnosis, dementia-friendly design, and community support are needed. Such approaches can contribute to reducing institutional transitions and caregiver burdens.