Do walking-friendly built environments influence frailty and long-term care insurance service needs?

Our study examined the associations between neighborhood walkability, frailty, and the incidence of long-term care insurance (LTCI) service needs using a prospective cohort survey in a suburban town in Japan. The final sample for analyses comprised 2867 community-dwelling older adults (mean age: 73.0 years). Neighborhood walkability was measured using the Walk Score®. A total of 387 participants (13.5%) exhibited frailty. The odds of frailty, adjusted for the covariates (sex, age, educational status, marital status, residential status, employment status, subjective economic status) among participants who lived in somewhat walkable/very walkable areas, was 0.750 (95% Confidence Interval, CI: 0.597–0.943) versus those who lived in car-dependent areas. During the 23-month follow-up, 102 participants needed LTCI services (19.0 per 1000 person-years), 41 of whom (21.0 per 1000 person-years) lived in car-dependent areas, and 61 of whom (17.9 per 1000 person-years) lived in somewhat walkable/very walkable areas. As compared with participants who lived in car-dependent areas, the incidence of LTCI service needs was not significantly lower than that of those who lived in somewhat walkable/very walkable areas. Walk Score® can provide the critical information for the strategies to improve walkability and prevent older adults’ frailty in less walkable areas, contributing to achieving the United Nation’s Sustainable Development Goals (SDGs).