Aging in Place or Institutionalization? A Multiscale Analysis of Independent-Living Older Adults From Four Large Cities in China's Yangtze River Delta.

Background and Objectives: Aging in place (AIP) has been adopted as a key strategy to cope with the global public health challenge posed by population aging. The current study aimed to understand the association between older adult's AIP preference and various social and physical environmental factors at different scales. Research Design and Methods: Following the ecological model of aging, this paper conducted a questionnaire survey of 827 independent-living older adults (60 years old and above) from four big cities in China's Yangtze River Delta region and employed a structural equation modeling method for analysis. Results: Older adults from more developed cities exhibited a stronger preference for AIP than those from less developed cities. Individual characteristics, mental health, and physical health had a direct impact on AIP preference, whereas the effect of the community social environment was not significant. The perceived and objectively measured community-built environment indirectly affected AIP preference via mediation and chain effects. Discussion and Implications: Complex paths affecting AIP preference were identified. At the city level, the social environment had a stronger influence than the physical environment on AIP, and the opposite pattern was observed at the community level. Mental health and physical health had opposite effects on AIP preference. Although physical health was negatively associated with AIP, age-friendly communities with compact, diverse, and accessible built environments have a positive impact on older adults' physical health and therefore should be promoted.