The Role of the Built Environment in Social-Health Outcomes of Older Adults with Knee Osteoarthritis and Falls

Year Submitted: 2025
Published Date: 20 February 2026

Tags: Quantitative Research, Chronic Care, Population Health, Preventive Care, Care Continuum, Build Environment, Care Process ＆ Redesign, Applied/Translational Research

About this Content

Aims

This study seeks to understand how the built environment (BE) could support social-health outcomes of older adults with knee osteoarthritis (OA) and falls. It hypothesizes that BE is correlated with social connectedness and loneliness. Besides that, BE-related improvements, higher social connectedness and lower loneliness could increase physical activity and life-space mobility.

Background

The BE plays a crucial role in shaping opportunities for both mobility and social participation, particularly for older adults with mobility challenges. Current literature shows a gap in wholistically understanding the relationship between the BE, and social isolation and loneliness of older people with increasing frailty, and impact on their physical activity, participation and functional outcomes.

Methods

A cross-sectional study was conducted with 289 adults aged 45 years with knee OA (N=186) and/or a history of falls (N=172) from three public hospitals in Singapore. The Age-Friendly Environment Assessment Tool (AFEAT), International Physical Activity Questionnaire (IPAQ), 3-item Loneliness Scale, Lubben Social Network Scale, University of Alabama at Birmingham Life-Space Assessment (UAB-LSA), and Knee Injury and Osteoarthritis Outcome Score-12 (KOOS-12) were administered. Spearman correlation and adjusted linear regression analyses were run to explore relationships among the variables.

Results

The BE (BE-specific questions in AFEAT) was positively associated with physical activity (IPAQ), while loneliness was negatively associated with life-space mobility (UAB-LSA). For people with knee OA, IPAQ was positively related to their functional outcomes (KOOS-12). We also observed a significant weak to moderate correlation between BE with social connectedness (Lubben) and loneliness.

Conclusion

Results indicate that the BE, loneliness and social connectedness could influence the functional and health outcomes of older adults with knee OA and falls, by facilitating their physical activity and life-space mobility. Further studies should be undertaken to determine the directional impacts among the related variables, to contribute toward a framework which elucidates the relationship between the BE and social-health outcomes of people experiencing OA and falls.

Lessons Learnt

Beyond clinical outcomes, designing age-friendly environments may reduce loneliness and improve mobility, pointing to broader public health and urban planning responsibilities.
Confirmatory factor analysis showed that BE-related questions in AFEAT (walkability, safety, and access to amenities) clustered as a single construct, suggesting it may be useful to group these items together in future applications of the tool.

Additional Information

Singapore Health and Biomedical Congress 2025, Best Poster Award (Clinical Research) - Bronze
National Research Foundation CREATE Thematic Grant

Keywords

Knee Osteoarthritis, Falls, Built Environment, Social networks, Loneliness, Participation, Physical Activity

Innovators' Details

Connect with this contributor!

Neha Seayad - neha.seayad@ntu.edu.sg

Project Attachment

BP-CR-03 Poster.pdf