Age-friendly community environments and the age trajectories of long-term care dependency among Chinese older adults

In the context of rapid global aging, the importance of age-friendly community environments for promoting healthy aging and "aging in place" continues to increase. Using data from the 2011-2020 China Health and Retirement Longitudinal Study, this study investigated the impact of an age-friendly community environment on the age trajectories of late-life long-term care (LTC) dependency among older Chinese adults aged 60+ years. Age-friendly community environments were defined according to three levels (poor, moderate, or good) based on the World Health Organization's age-friendly city and community framework, and LTC dependency was classified as level 1 (high), level 2 (medium), or level 3 (low) according to activities of daily living and instrumental activities of daily living scores. We classified participants into two age trajectory groups according to their level of LTC dependency: early-onset and late-onset groups. We found that an age-friendly community environment, especially a good housing environment, was consistently associated with the probability of having late-onset LTC dependency at any level. Having moderate and good social and employment environments reduced the likelihood of having early-onset level 2 and level 3 LTC dependency. Our mechanism analysis also revealed that age-friendly community environments affect LTC dependency through social participation. Our results may help elucidate the importance of promoting age-friendly community environments to maintain late-life functional ability and support healthy aging.