Original Study| Volume 22, ISSUE 3, P590-597.e1, March 2021

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Differences in the Association of Neighborhood Environment With Physical Frailty Between Urban and Rural Older Adults: The Korean Frailty and Aging Cohort Study (KFACS)

  • Yuri Seo
    Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Republic of Korea
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  • Miji Kim
    Address correspondence to Miji Kim, PhD, Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul 02447, Republic of Korea.
    Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea
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  • Hayoung Shim
    Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Republic of Korea
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  • Chang Won Won
    Chang Won Won, PhD, Department of Family Medicine, College of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea.
    Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Published:November 18, 2020DOI:



      We examined the difference in the relationship between perceived neighborhood environments and physical frailty between urban and rural older adults.


      Cross-sectional study.

      Setting and Participants

      Urban and rural community in South Korea; a total of 2593 community-dwelling older adults aged 70-84 years (mean age: 76.0 years, 51.0% women) in the Korean Frailty and Aging Cohort Study (KFACS).


      The neighborhood environment was assessed using the 17-item Environmental Module of the International Physical Activity Questionnaire (IPAQ-E). The IPAQ-E had 7 environmental factors (residential density, access to destinations, neighborhood infrastructure, neighborhood safety, social environment, aesthetic qualities, and street connectivity). Physical frailty was defined using the Fried frailty criteria with modified cutoffs.


      The number of participants residing in urban and rural areas was 1902 and 691, respectively. The prevalence of frailty was 5.3% and 12.0% in urban and rural areas, respectively. In urban areas, frailty was associated with the total IPAQ-E score (β = −0.007, P = .009) after adjusting for confounding factors. There was no association in the rural areas (β = −0.003, P = .535). In urban older adults, logistic regression showed that absence of destination [odds ratio (OR) 2.58, 95% confidence interval (CI) 1.36-4.90] and no crime safety at night (OR 2.00, 95% CI 1.12-3.57) were associated with a higher risk of frailty. In rural older adults, poor access to recreational facilities (OR 2.17, 95% CI 1.07-4.40) and no aesthetics (OR 2.49, 95% CI 1.22-5.10) were associated with frailty.

      Conclusions and Implications

      Our study indicated that the presence of destination and crime safety at night was significantly associated with physical frailty among older adults living in urban areas, whereas aesthetics and recreational facilities were significantly associated with physical frailty in rural older adults.


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