Neighbourhood-level age-friendliness in urban environments: associations with functional independence and physical activity in older adults after a fall

Background: Population ageing and urbanisation are reshaping living environments and raising new challenges for promoting health and independence in later life. Age-friendly city initiatives aim to support active ageing, yet the relationship between environmental conditions, housing factors, and functional outcomes remains insufficiently understood. Methods: This cross-sectional study analysed data from participants of the SeFallED study in Oldenburg, Germany, which enrolled community-dwelling older adults (≥60 years) presenting to the emergency department due to a fall. Physical activity was assessed using accelerometry and self-report, life-space mobility using the Life-Space Assessment, and independence using instrumental activities of daily living (iADL). Neighbourhood-level age-friendliness was quantified using the Age-Friendly Cities and Communities Questionnaire (AFCCQ). Multiple linear regression models examined associations between environmental factors, housing characteristics, and outcomes. Results: In total, 179 participants (mean age 77.3 ± 7.9 years) were included in the study. Neighbourhood-level age-friendliness showed limited associations with active physical activity outcomes, but was associated with sedentary behaviour. Higher age and widowhood were consistently linked to lower activity levels, while higher age-friendliness scores were significantly associated with lower life-space mobility and lower independence, indicating greater functional limitations. Conclusion: Findings suggest that age-friendly environments may be particularly relevant for older adults after a fall with reduced mobility and independence. Evaluations of age-friendly city initiatives should, therefore, consider not only behavioural activation but also the maintenance of functioning in vulnerable populations. Longitudinal research is needed to clarify causal pathways and the dynamic interplay between person and environment in ageing societies.