Title: SPACE: Supportive environments for Physical and social Activity, healthy ageing and CognitivE health
Funder: Economic and Social Research Council

Abstract: As the majority of the global population now live in cities, it is important that urban environments support healthy ageing. Urban environments (encompassing natural, built and social environments) are important determinants of physical and cognitive health. We know that urban environments predict a variety of health outcomes for ageing individuals and can facilitate social interaction and cohesion. Improving cognitive health and reducing cognitive health inequalities requires policies and practices that provide supportive urban environments. Creative urban design can support and encourage individuals and populations to socially engage and adopt or sustain healthier lifestyles. However, this needs a robust evidence base and advocates who can articulate how supportive urban environments can improve cognitive health and reduce cognitive health inequalities. Social and physical environments are elements of a complex system, certain features of which can makes us vulnerable to developing cognitive disorders (cognitive health inequality). What is not clear, however, is 'how' the complex and dynamic interdependencies between these factors confer on urban environments a risk for cognitive ill-health. We do not fully understand the pathways and interdependencies by which urban environments lead to cognitive disorders and inequalities. In turn, we do not know how to effectively intervene to improve outcomes within this complex system. Our overarching aim is to investigate the impacts, and possible mechanistic pathways, of urban environments on healthy ageing and cognitive health, and on diverse individuals and communities, through the novel integration of multi-omics, lifestyle behaviour and environmental exposures from urban environments, to ensure that we create healthy active places that are supportive, attractive and accessible to people as they age. We focus on the outdoor urban environment (see Fig 1) (i.e. domestic environments, such as internal air quality, are beyond the scope of this project). This proposal meets the Challenge goals by completing the following objectives: 1. Using Participatory Group Model Building and findings from a mechanistic systematic review to develop a system-based, evidence-informed conceptual framework depicting the shared understanding of the systems perpetuating environmentally determined cognitive decline and the possible causal pathways between the urban environment, related environmental exposures, lifestyle behaviours (social engagement, physical activity), biological factors and cognitive health. (Work Package (WP)1). 2. To create and develop spatial environmental data linked to an extant healthy ageing cohort (NICOLA study) which has existing brain and cognitive health assessments and lifestyle behaviours, to investigate the joint and independent contributions of urban environments, related environmental exposures and lifestyle behaviours to cognitive health (WP2). 3. Using more granular measures, to investigate the possible mechanistic pathways by which the urban environment influences cognitive health (WP3). 4. Using exploratory multi-nomic approaches, to investigate the biological responses to urban environments and related environmental exposures that influence measures of cognitive health (WP4). 5. Using Citizen Juries and expert panels, to engage with multi-sectoral stakeholders and older people to co-develop and 'sense check' strategies to promote cognitive health through supportive urban environments. This will lead to the co-development and implementation of a framework for collaborative knowledge generation and synthesis, and will help us explore the public and political acceptability, utility, affordability, feasibility and sustainability of prevention policies and interventions to improve cognitive health, prevent cognitive decline and reduce cognitive health inequalities (WP5).

Lay abstract: The number of people worldwide living with dementia and cognitive impairment is increasing, mainly due to people living longer, so we want to figure out how where we live affects dementia and brain health as we get older. Some research suggests that where we live might influence our brain health. For example, poor air quality in towns and cities, can lead to a decline in brain health. As more of us now live in towns and cities, it is important that the environment where we live is scientifically designed and improved to maximise our brain health. The complex social and physical environments where we live make some people more vulnerable than others to developing cognitive impairment. In other words, the factors that account for who is most likely to develop cognitive ill-health due to the environment has less to do with 'how' we live and more to do with 'where' we live. We do not know how these factors interact to make urban environments a problem for brain health, nor which are the best policies and interventions for promoting healthy ageing and brain health for our poorest communities. Our project will provide evidence for policies and practices that provide supportive urban environments to promote healthy ageing, including promoting brain health. This could include using creative urban designs to support people to adopt and maintain healthier lifestyles such as being more active. However, this needs a strong evidence base with expert community advocates who can articulate how supportive urban environments can improve brain health. Our research has the following steps: 1. First, with the help of stakeholders, including those from business, industry, and local government, and a review of existing research, we will represent the relationships between our biology, our lifestyles and our environment in a diagram illustrating how they likely interact to affect brain health, because visual thinking can help stakeholders better identify possible intervention sweet-spots to improve brain health. 2. By analysing data from over 8,000 older people in Northern Ireland, and linking this to information about where they live, such as the amount of air pollution, the toxins in soil, or how walkable their neighbourhoods are, we will explore how different environmental factors relate to brain health. 3. Next, we will collect new data on a subgroup of 1,000 older people including more in-depth measures of brain health and better measures of physical activity, using GPS devices worn around the waist that monitor our locations. This will allow us to explore how the urban environment influences our brain health. 4. Then, we will explore how aspects of our biology play a role in how the urban environment affects our brain health. 5. We will host workshops with local citizens to 'sense-check' our findings and co-develop promising prevention approaches. In these, we will explore the acceptability, affordability, feasibility and sustainability of new initiatives to improve the environmental influences on brain health. This might include, for example, policies on: expanding the car-free areas of the city to reduce air pollution; increasing the number of footpaths and cycle paths to encourage walking and cycling; improving public transport to reduce car use. As a result of our research we will produce: 1. A map of the system in which our genes, lifestyle behaviours and urban environments interact to affect brain health, to help guide stakeholders towards policies and programmes that can improve brain health. 2. An evidence base exploring how where we live affects our brain health. 3. A suite of potential policies and interventions to improve brain health and promote healthy ageing 'tested' (in terms of acceptability and feasibility) with older people, business, industry, policymakers and other stakeholders.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT
Health categories: NEUROLOGICAL