Residential greenness, activities of daily living, and instrumental activities of daily living: A longitudinal cohort study of older adults in China.

Journal Article (Journal Article)

We aimed to explore whether higher levels of residential greenness were related to lower odds of disabilities in activities of daily living (ADL) and instrumental activities of daily living (IADL).


We included older adults 65 years of age or older from the Chinese Longitudinal Healthy Longevity Survey. Our exposure was Normalized Difference Vegetation Index in 500 m radius around residence. Our outcome was ADL and IADL. We used binary logistic regression and mixed-effects logistic regression to estimate the odds of ADL and IADL disabilities.


A total of 36,803 and 32,316 participants were included for the analysis of ADL and IADL, with 71.6% free of ADL disability and 47.3% free of IADL disability. In the logistic regression model, compared with the participants living in the lowest quartile of residential greenness, those in the highest quartile had a 28% (odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.65, 0.79) lower odds of ADL disability and a 14% (OR = 0.86; 95% CI = 0.77, 0.95) lower odds of IADL disability. A similar association was found in the mixed-effects logistic regression models. During the follow-up period, 5,004 and 4,880 healthy participants developed ADL and IADL disabilities. Per 0.1-unit increase in baseline annual average Normalized Difference Vegetation Index (NDVI) was related to an OR of 0.95 of developing ADL disability (95% CI = 0.93, 0.98) and IADL disability (95% CI = 0.91, 0.98).


Our study suggests that increasing green space is associated with lower odds of ADL and IADL disabilities, which may reduce caregiver burden of long-term care for Chinese older adults.

Full Text

Duke Authors

Cited Authors

  • Zhu, A; Yan, LL; Wu, C-D; James, P; Zeng, Y; Ji, JS

Published Date

  • October 14, 2019

Published In

Volume / Issue

  • 3 / 5

Start / End Page

  • e065 -

PubMed ID

  • 33195964

Pubmed Central ID

  • PMC7608893

Electronic International Standard Serial Number (EISSN)

  • 2474-7882

International Standard Serial Number (ISSN)

  • 2474-7882

Digital Object Identifier (DOI)

  • 10.1097/ee9.0000000000000065


  • eng