Equipped with smartphones for a week, dozens of older New York City residents allowed a Cornell sociologist to track their movements and reported several times a day where they were, what they were doing and how they felt.
The 61 study participants, all age 55 or older, shared glimpses of their daily routines and activities: working at a bakery, being at home with a cat, walking in a park with grandchildren, visiting friends, waiting in line for coffee and going to church. They also noted when they saw litter, vacant buildings, damaged sidewalks and other scenes they considered problematic, such as evidence of drug or alcohol use.
In the places they perceived as stressful or threatening, the older adults were significantly more likely to report momentary spikes in fatigue or pain, the study found. When observing at least two of those disorderly conditions, they were twice as likely to report feeling tired and about two-thirds more likely to report feeling pain.
“These fluctuations may have longer-term impacts on health and well-being for older adults who have to navigate demanding or distressing social environments on a regular basis,” said Erin York Cornwell, associate professor of sociology in the College of Arts and Sciences.
York Cornwell collected the data and is lead author of “Neighborhood Disorder and Distress in Real Time: Evidence from a Smartphone-Based Study of Older Adults,” published Nov. 19 in the Journal of Health and Social Behavior. Her co-author, Alyssa Goldman ’07, Ph.D. ’20, is an assistant professor of sociology at Boston College.
The study’s innovative research approach – using smartphones to capture location and real-time survey data – highlights promising new opportunities to examine how social environments encountered in everyday life may affect health, York Cornwell said.
York Cornwell is part of a team applying the same research methods in a larger study funded by the National Institute on Aging and National Science Foundation, which will compare the mobility and health of older Chicago residents before and during the coronavirus pandemic.
In New York City, York Cornwell worked with community-based senior centers to recruit a diverse group of volunteers from four neighborhoods: East Harlem, Gramercy and the north and south sections of Bedford-Stuyvesant. A nonprofit partner, Older Adults Technology Services, helped train them in how to operate iPhones the study provided and an app that alerted them to respond to surveys sent at random times during four daily windows, from morning to evening.
On average, about one-third of the study participants reported feeling some pain and about one-third some fatigue in any given survey, with those feelings being less prevalent in more orderly spaces. The risk increased with each additional condition of disorder observed.
Sociologists have documented extensively the links between living in a disadvantaged neighborhood – where people are more likely to encounter distressing, demanding or threatening conditions – and a variety of health risks.
Taking advantage of the ability to track study participants all day and collect real-time feedback through the smartphones, York Cornwell took a broader view. She considered the older adults’ “activity spaces,” including not just where they lived but where they worked, volunteered, shopped, received medical care and visited friends or relatives – often outside their own neighborhoods.
“This relationship between your immediate environment and being more likely to feel pain or fatigue is not limited to the conditions of your residential neighborhood,” York Cornwell said. “Wherever you are, if you are seeing these conditions of disorder, the more of them you see, the more likely you are to report pain or fatigue.”
Even if fleeting, the researchers said, those feelings over time could compound and contribute to longer-term health issues and health inequities for those with the most exposure to distressed environments.
York Cornwell noted that the older adults participating in the study completed most of the surveys – technically called “ecological momentary assessments,” or EMAs – within 10 or 15 minutes of being pinged on their smartphones to complete one. Their overall response rate of nearly 99% is almost unheard of in survey research, she said.
Researchers typically have relied on survey respondents to keep paper logs of their experiences, often recorded long after events occurred. Though still an emerging research method, York Cornwell said, smartphone-based data collection enables more immediate responses that promise to improve survey accuracy and reduce bias.
“It’s an incredible tool for understanding how people experience and perceive their environments in real time, and then looking at how those environments may affect their health,” she said. “We haven’t been able to get that insight in such a clean way in the past, so this approach has really exciting implications.”