Urban Quality, Cognitive Impairment, Frailty, and Polypharmacy in Older Adults: A Cross-Sectional Geospatial Analysis from the PIEI-ES Study (Preprint)

BACKGROUND Cognitive and physical frailty and polypharmacy in older adults are influenced by modifiable urban determinants, including built-environment attributes, access to services, and availability of green spaces. OBJECTIVE To examine the association between GIS-derived measures of urban quality and proximity to key urban resources and cognitive impairment, physical and cognitive frailty subtypes, and polypharmacy among older adults. METHODS We conducted a cross-sectional geospatial study including 317 adults aged ≥65 years from the PIEI-ES cohort residing in the urban area of Talca, Chile. Physical frailty was assessed using the Fried phenotype and cognitive impairment using an abbreviated Mini-Mental State Examination. Polypharmacy was defined as the daily use of ≥5 medications. Residential addresses were geocoded and linked to a GIS database of health services, community facilities, and main squares and parks. A summary index of urban quality was constructed from Euclidean distances to these resources and analyzed in quartiles and as a binary indicator using cutoffs of ≤18 and ≤16 points. Statistical analyses included t tests, Mann-Whitney, ANOVA, and logistic regression models. RESULTS Cognitive impairment was present in 25.2% (80/317) of the sample and was associated with older age (76.6 vs 72.5 years; P