Residential environment and depressive symptoms among Chinese middle- and old-aged adults: A longitudinal population-based study

Associations between perceived built environment and depressive symptoms in China: The mediating roles of neighborly relationships and community attachment across age-gender groups

BACKGROUND

While prior research has linked the built environment to mental health, little attention has been given to how this relationship and its mechanisms differ at the intersection of gender and age. This study examines the direct and indirect associations between the perceived built environment and depressive symptoms, with neighborly relationships and community attachment as mediators. It also investigates how these associations vary across age-gender groups.

METHODS

Drawing from nationally representative data from two waves of the China Family Panel Studies (n = 14,200), this study applied a moderated mediation model to analyze the mediating role of neighborly relationships and community attachment, as well as the moderating role of age-gender groups.

RESULTS

The perceived built environment was negatively associated with depressive symptoms, and this relationship was mediated by both neighborly relationships and community attachment. Age-gender groups moderated both the direct and indirect associations, with middle-aged males exhibiting the strongest direct association, while middle-aged females demonstrated more pronounced indirect associations through social cohesion.

LIMITATIONS

This study relied on self-reported data to assess the built environment, and both neighborly relationships and community attachment were measured using single-item indicators, which may limit the depth of analysis. Furthermore, the observational design of the study precludes definitive causal inferences from the findings.

CONCLUSIONS

The study reveals varying associations between the perceived built environment and depressive symptoms across age-gender groups, with middle-aged males more affected by environmental stressors and middle-aged females benefiting from social cohesion. These findings provide insights for targeted interventions and policies.

Childhood Housing Condition and Old Age Health Among Chinese: The Mediation Role of Adulthood Socioeconomic and Medical History

Guided by the lifecourse perspective and social determinants of health framework, this study examined the association of childhood housing with old age health among Chinese and its midlife mediators. Respondents were middle-aged and older adults (aged 45+) from the China Health and Retirement Longitudinal Study (N = 12,842). They were asked about their childhood housing conditions (e.g., if their houses had clean water, water toilet, and electricity). Adulthood socioeconomic and medical history and middle- and old-age health were measured. Causal mediation analysis showed childhood better housing was directly associated with fewer depressive symptoms and better cognition in middle- and older-age, and indirectly through increasing education level. However, the proportion-mediated estimate had very wide confidence intervals. Our findings suggested the importance of broad infrastructure development and adult continuing education programs among those who grew up in poor housing conditions to promote mental health in older age.

Association between cooking with solid fuels and depressive symptoms among middle-aged and older adults in China: The mediating effect of the residential environment

BACKGROUND

Depression is a common issue among elderly people in both developing and developed countries. Existing research indicates that cooking with solid fuels has a negative impact on the mental health of middle-aged and elderly people (aged 45 and older). However, the potential role of the residential environment in this process is not yet clear. Clarifying this issue may help identify effective interventions to improve public health for elderly people. This study aimed to explore the association between cooking with solid fuels and depressive symptoms, as well as the potential mediating role of the residential environment in this relationship.

METHOD

This study utilized cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS) for 2020, involving approximately 19,000 respondents aged 45 years and older. Propensity score matching (PSM) was used to explore the association between cooking with solid fuels and depressive symptoms. Additionally, a range of potential covariates were adjusted, and the Sobel test was applied to assess the potential mediating effect of the residential environment on this relationship.

RESULTS

According to the fully adjusted model, cooking with solid fuels was significantly associated with an increased risk of depressive symptoms in middle-aged and older adults (β = 0.315, P < 0.001), and this finding was confirmed through robustness tests using different propensity score matching methods. Heterogeneity analysis revealed that this association was particularly significant among men (β = 0.318, P < 0.001), those aged 60-74 (β = 0.347, P < 0.001), and individuals with a middle school education (β = 0.353, P < 0.001). Mediation effect analysis revealed that indoor cleanliness (β = 0.0090, P < 0.001), indoor broadband coverage (β = 0.0077, P < 0.001), and the installation of indoor air purifiers (β = 0.0010, P < 0.1) mediated the relationships between cooking with solid fuels and depressive symptoms.

CONCLUSION

Given the growing attention given to improving indoor environments and enhancing mental health, the findings of this paper highlight that improving indoor cleanliness, increasing broadband coverage indoors, and installing air purifiers can effectively intervene in and prevent depressive symptoms caused by cooking with solid fuels.

Dwelling characteristics and mental well-being in older adults: A systematic review

The increasing prevalence of mental health challenges in older adults underscores the need for a comprehensive understanding of the interplay between dwelling characteristics and mental health outcomes. This systematic review aims to investigate house characteristics associated with mental well-being in older adults. The review meticulously explores existing literature from databases such as PubMed, Scopus, Web of Science, and the Google Scholar search engine. The Newcastle-Ottawa Scale (NOS) was utilized to assess the quality of the included articles. Out of an initial 1182 references, 21 pertinent articles published between 2002 and 2023 were included in the study. While the geographical scope was global, a notable concentration of studies was observed in China. The synthesis of studies reveals that specific attributes of dwelling characteristics, such as high-rise and multi-floor houses, larger house size, high house quality, bathing facilities, and the use of clean fuels for heating and cooking, positively impact mental health outcomes in older adults. However, inconsistent results were found regarding the impact of construction materials on mental health outcomes. Further research is warranted to deepen our understanding of the intricate relationship between construction materials and mental health outcomes. These findings underscore the importance of considering specific dwelling characteristics in designing interventions to enhance the mental well-being of older adults, necessitating targeted strategies for creating age-friendly living environments.

Association of indoor solid fuel use and long-term exposure to ambient PM2.5 with sarcopenia in China: A nationwide cohort study

BACKGROUND

Little is known about the association between air pollution exposure and sarcopenia in Asia. We aimed to investigate the associations of indoor solid fuel use and long-term exposure to ambient fine particulate matter (PM2.5) with sarcopenia in China.

METHODS

Using a nationally population-representative study, 12,723 participants aged at least 45 years across 125 cities from the China Health and Retirement Longitudinal Study were enrolled in 2011, and further 3110 participants were followed up until 2013. Sarcopenia status was classified according to the Asian Working Group for Sarcopenia 2019 criteria. Household fuel types used for heating and cooking were assessed using a standard questionnaire. Ambient annual PM2.5 was estimated using satellite-based spatiotemporal models. Multinomial logistic regression as well as the multiplicative interaction and additive interaction analysis were used to explore the associations of indoor solid fuel and ambient PM2.5 with different status of sarcopenia.

RESULTS

Of the 12,723 participants, 6071 (47.7%) were men. In the cross-sectional analyses, compared with clean fuel, using solid fuel for heating and cooking, separately or simultaneously, was significantly associated with a higher risk of both possible sarcopenia and sarcopenia. Each 10 μg/m3 increment of PM2.5 was positively related to possible sarcopenia (adjusted odds ratio, [aOR] 1.04, 1.02-1.07) and sarcopenia (1.06, 1.01-1.12). We found a significant interaction between solid fuel use for heating and ambient PM2.5 exposure with possible sarcopenia. During a two-year follow-up, solid fuel use was associated with incident possible sarcopenia (aOR 1.59, 1.17-2.15). These associations did not differ by sex and age, while participants living in a house with poor cleanliness might have a higher risk of sarcopenia.

CONCLUSIONS

Indoor solid fuel use and long-term exposure to ambient PM2.5 were associated with a higher risk of sarcopenia among Chinese adults. These findings provide implications for promoting healthy aging by reducing air pollution.

Driving the determinants of older people's mental health in the context of urban resilience: a scoping review

BACKGROUND

Population aging is a pervasive phenomenon occurring rapidly worldwide, while sustainable development goals are considered the mental health among older adults.

METHODS

To investigate the factors affecting mental health, we conducted a scoping review of the 47 papers published between 2015 and 2022 to explore various dimensions affecting older adults' mental health.

RESULTS

Our finding mirrors four dimensions of creating healthy and sustainable environments for older adults: person, place, processes, and resilience-related health in the living environment. The person dimension includes individual characteristics, attitudes and behaviors, and health status. The place dimension is divided into five categories: land use, access, physical form, public open spaces, and housing, while the process consists of the social, cultural, and economic environments. Resilience-related health dimension emphasizes the impact of natural and man-made disasters on older people's mental health.

DISCUSSION

These findings can provide policymakers insights into developing community-based environmental intervention strategies to promote mental health among older adults and support healthy and active aging.

Depression prediction based on LassoNet-RNN model: A longitudinal study

Depression has become a widespread health concern today. Understanding the influencing factors can promote human mental health as well as provide a basis for exploring preventive measures. Combining LassoNet with recurrent neural network (RNN), this study constructed a screening model ,LassoNet-RNN, for identifying influencing factors of individual depression. Based on multi-wave surveys of China Health and Retirement Longitudinal Study (CHARLS) dataset (11,661 observations), we analyzed the multivariate time series data and recognized 27 characteristic variables selected from four perspectives: demographics, health-related risk factors, household economic status, and living environment. Additionally, the importance rankings of the characteristic variables were obtained. These results offered insightful recommendations for theoretical developments and practical decision making in public health.

Economic development, weak ties, and depression: Evidence from China

OBJECTIVES

Weak ties are becoming mainstream in daily relationships and play an essential role in the improvement of individuals' mental health. Despite growing concerns on depression, inclusion of weak ties is limited. To address the gap, this study empirically shed light on the role of weak ties on individual depression in the context of economic development.

METHOD

A cross-sectional study was conducted based on 2018 China Health and Retirement Longitudinal Study (CHARLS) with a sample of 16,545 individuals. A moderated mediation model is constructed to evaluate the impact of economic development (GDP) on the degrees of depression, the mediating effect of weak ties, and the moderating effect of residents' residence types (living in urban or rural areas).

RESULTS

Economic development exerts a significant direct impact on depression (β=-1.027, p<0.001). Weak ties are significantly negatively correlated with depression (β=-0.574, p<0.001), and act as a mediator between economic development and local individual depression. In addition, the residence type plays a moderating role between economic development and weak ties (β=0.193, p<0.001). That is, living in urban areas would introduce the higher the level of weak ties.

CONCLUSIONS

Higher economic development is largely conducive to alleviating the degrees of depression, weak ties play a mediating role in economic development and depression, and residence types have a positive moderating effect on the economic development and weak ties.

Urbanization and depressive symptoms among middle-aged and older adults in China

Aims

Urbanization plays an important role in individuals' health. However, it is difficult to isolate healthy migrant effect between urbanization and health. This study examined the effects of urbanization on depressive symptoms and its possible pathways among Chinese middle-aged and older adults independent of the influence of health-selective migration.

Methods

Using the baseline survey of the China Health and Retirement Longitudinal Study, this study compared the depressive symptoms among three groups (urbanized rural residents, rural non-migrants and urban non-migrants). The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) short form was used to measure depressive symptoms. Logistic regression models and Structural Equation Model (SEM) were applied to examine the association between urbanization and depressive symptoms and the corresponding potential mechanisms.

Results

Our final sample contained 11,156 respondents with an average age of 58.91 (SD = 9.48), with 5,142 males (46.09%) and 6,014 females (53.91%). Compared with urbanized rural residents, rural residents were more likely to have depressive symptoms (OR = 1.19, 95% CI = 1.07, 1.32), and urban residents were associated with a decreased risk of depressive symptoms (OR = 0.81, 95% CI: 0.70, 0.94). A large proportion of the association between urbanization and depressive symptoms were mainly mediated by social participation, income and living conditions.

Conclusions

Planned urbanization had an independent impact on decreased depressive symptoms. Improvements in social participation, income and living conditions are the main drivers behind this relationship. Additionally, urbanization compensates for the negative impact of depressive symptoms from disadvantaged early life conditions, but it cannot eliminate the gap between urbanized rural people and urban non-migrants.

Effects of pain and depression on the relationship between household solid fuel use and disability among middle-aged and older adults

Household air pollution (HAP) is suggested to increases people's risk of disability, but mediating mechanisms between HAP and disability remains under-investigated. The aim of this study was to investigate the underlying mechanisms between household air pollution and disability in middle-aged and older adults (i.e., older than 45 years) using a nationally representative prospective cohort. In total, 3754 middle-aged and older adults were selected from the China Health and Retirement Longitudinal Study. Correlation analysis and logistic regression analysis were employed to estimate the association between HAP, pain, depression and disability. Finally, three significant mediation pathways through which HAP directly impacts disability were found: (1) pain (B = 0.09, 95% CI 0.01, 0.02), accounting for 15.25% of the total effect; (2) depression (B = 0.07, 95% CI 0.004, 0.02), accounting for 11.86% of the total effect; (3) pain and depression (B = 0.04, 95% CI 0.003, 0.01), accounting for 6.78% of the total effect. The total mediating effect was 33.89%. This study clarified that HAP can indirectly affect disability through the respective and serial mediating roles of pain and depression. These findings potentially have important implications for national strategies concerning the widespread use of clean fuels by citizens.

Association between household air pollution from solid fuel use and risk of chronic diseases and their multimorbidity among Chinese adults

BACKGROUND

Given the increasing burden of chronic conditions, multimorbidity is now a priority for public health systems worldwide. However, the relationship between household air pollution (HAP) exposure with multimorbidity remains unclear.

METHODS

We used three waves data (2011, 2013, and 2015) including 19,295 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study, to investigate the association between HAP exposure from solid fuel use for heating and cooking with the risk of chronic multimorbidity. Multimorbidity was defined as the coexistence of two or more of 15 chronic diseases (hypertension, diabetes, dyslipidemia, heart disease, stroke, cardiovascular disease, chronic lung disease, asthma, kidney disease, liver disease, digestive disease, cancer, psychiatric disease, memory-related disease, and arthritis). Multiple logistic regression investigated the association between solid fuel use for heating and cooking, separately or simultaneously, with the risk of multimorbidity. Poisson regression with quasi-likelihood estimation explored whether solid fuel exposure could increase the number of morbidities. Stratified analyses and sensitivity analyses examined the effect modification and robustness of the association.

RESULTS

Of the 19,295 participants (mean age: 58.9 years), 40.9 % have multimorbidity. Compared with participants who used clean fuels for heating and cooking, the risk was higher in mixed fuel (adjusted odds ratio, aOR = 1.26, 95 %CI:1.16-1.36) and solid fuel users (aOR = 1.81, 1.67-1.98) separately. HAP from solid fuel use was positively associated with an increased number of morbidities (adjusted β = 0.329, 0.290 to 0.368), after controlling for confounders. Those living in a one-story building, with poor household cleanliness have a higher risk of multimorbidity. No significant modifications of those associations by the socio-demographic and behaviour characteristics was observed.

CONCLUSIONS

HAP from solid fuel use is associated with a high risk of chronic multimorbidity in Chinese adults. Our findings provide important implications for reducing chronic disease burden by restricting solid fuel use.

The Ancient Town Residential Environment of the Elderly in Xiangxi Tujia: Survey, Questions, and Recommendations

This study uses behavioral observation, interviews, and questionnaire research to investigate the residential environment. It also evaluates the elderly in four representative ancient towns of Xiangxi, namely, Liye Ancient Town, Furong Ancient Town, Liexi Ancient Town, and Xichehe Ancient Town. It includes indoor air (CO₂, PM_2.5, PM₁₀) and light intensity monitoring for the residential environment. The results showed that the elderly had a significant sense of frustration and loneliness. Of the elderyly, 70% believed the current living environment had an impact on healthy living, and 45% believed the safety and convenience of the living environment should be improved. More than 80% of the elderly were dissatisfied with their indoor acoustic environment, and more than 70% were dissatisfied with their home transportation. More than 85% of the elderly considered traditional wooden components and spaces to be the source of cultural identity. Furthermore, the average indoor PM_2.5 concentration during the fire pit fire was 350-600 µg/m³, about 4.7-8 times the Chinese standard value. The average concentration of PM₁₀ in all rooms was more than 400 µg/m³, approximately three times the Chinese standard value. Also, targeted environmental improvement strategies were proposed. The study results provided actual information to develop a systematic approach and a targeted design based on the needs to improve the residential environment of the elderly in ancient cities.

The Relationship Between Built Environment and Mental Health of Older Adults: Mediating Effects of Perceptions of Community Cohesion and Community Safety and the Moderating Effect of Income

Many studies revealed a significant correlation between low-density built environment and the mental health of older adults in developed countries. However, scholars and decision-makers recently began to pay close attention to the effect of this relationship in high-density built environments and in developing countries. Using point-of-interest (POI) data from Baidu and data on 20 communities in Guangzhou, China, which were collected through a questionnaire survey, this study aimed to examine the relationship between built environment and the mental health of older adults as well as the physiological–psychological mediating paths between the two, so as to enrich the research on population aging in the high-density urban context in developing countries. The findings indicated that facility accessibility and distance to parks significantly positively correlated with the mental health of older adults and the number of public transit stations, and the distance to these stations significantly negatively correlated with the mental health of older adults. Also, the perceptions of community cohesion and community safety had a significant mediating effect between the built environment and the mental health of older adults. Furthermore, the moderating effect analysis results verified the moderating effect of income: with an increase in income, the perception of community cohesion enhanced the protection of the mental health of older adults and reduced the mediating effect of the perception of community safety. The results provided a reference for policy-makers and urban planners in their efforts to plan and build health-supporting communities and a healthy aging society.

Indoor Environmental Quality of Residential Elderly Care Facilities in Northeast China

The indoor environmental quality is based on the indoor environmental performance of buildings, such as air temperature, lighting, and acoustics. These parameters have a specific impact on users' health and experience. This study explores the relationship between the indoor environment of residential elderly care facilities in cold regions and the sensitivity of the elderly to these facilities with the aim of improving the elderly care environment. This study measured the acoustic, lighting, and thermal environment in four residential elderly care facilities in Northeast China in spring, summer, autumn, and winter through a participant survey. In the residential elderly care facilities surveyed in this study, brightness and illuminance show a nonlinear relationship with lighting evaluation. With an increase in brightness and illuminance, the satisfaction of the lighting environment in different seasons first increases and then decreases. The relative humidity of the different types of rooms varies greatly in spring and less in winter. The average air quality score of the bedroom is higher than that of the activity room. The correlation between odor assessment and overall indoor environmental quality is very poor. The results of the questionnaire survey indicate that the participants were satisfied with the facilities' overall indoor environmental quality. This quality is affected by physical, environmental, and demographic factors. This study provides a reference for the design of other residential elderly care facilities.

Research on the Aging-Friendly Kitchen Based on Space Syntax Theory

As a result of aging populations globally, a growing number of older adults prefer to age in place; therefore, it is essential to study the spatial adaptability of the house. This study aimed to explore the relationship between the efficiency of daily activities and the spatial layout of home kitchens in the elderly population, and to assess the moderating role of cognitive function. Twenty-one elderly participants completed the experiment, including non-cognitively impaired (n = 12) and cognitively impaired groups (n = 9). Their home kitchen space was partitioned in plan and elevation based on space syntax theory. They were required to complete three tasks (i.e., an easy task, a medium task, and a difficult task) in their respective kitchens. The relationship between the efficiency of different tasks’ completion and the corresponding kitchen space attributes (integration, mean depth) was examined. The results showed a significant association between the home kitchen space layout of homebound older adults and their kitchen activity efficiency. In addition, a positive moderating effect of cognitive ability was found in the association between moderate and difficult tasks (p < 0.05), and its effect appeared to be stronger under challenging tasks (p < 0.01). The results of this study may help provide a basis for future design and optimization of aging-friendly residential spaces.

Association between community environment and depressive symptoms among Chinese middle-aged and older adults: evidence from national longitudinal surveys from 2011 to 2018

BACKGROUND

Despite the growing evidence on the relationship between community environment and depressive symptoms, little is known about the longitudinal relationship in older adults. This study aimed to examine the longitudinal association between community environment and depressive symptoms based on a nationally representative survey among Chinese middle-aged and older adults.

METHODS

A total of 6872 participants from the latest four waves (2011, 2013, 2015 and 2018) of China Health and Retirement Longitudinal Study were included. The Centre for Epidemiologic Studies Depression scale was used to measure depressive symptoms, and Cox proportional hazards regression models were conducted to investigate the longitudinal association between community environment and depressive symptoms after adjusting included covariates.

RESULTS

Both community infrastructure and organisations were significantly associated with depression, and infrastructure was associated with higher risk reduction in depression (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.66-0.89). Furthermore, we estimated the heterogeneous effects of community infrastructure and organisations for vulnerable populations. Additionally, family-based elder-care centre (HR, 0.63; 95% CI, 0.46-0.86) and outdoor exercise facilities (HR, 0.76; 95% CI, 0.68-0.84) were found as significant correlates associated with lower depressive symptom risk.

CONCLUSIONS

Our findings indicated that targeted and specific measures should be taken to improve the construction of community infrastructure and strengthen the role of community organisations. Specifically, providing a family-based elder-care centre and establishing outdoor exercise facilities might be effective methods to reduce the risk of depression and relieve related public health burdens among Chinese middle-aged and older adults.

The Effect of High-Density Built Environments on Elderly Individuals' Physical Health: A Cross-Sectional Study in Guangzhou, China

The built environment refers to the objective material environment built by humans in cities for living and production activities. Existing studies have proven that the built environment plays a significant role in human health, but little attention is paid to the elderly in this regard. At the same time, existing studies are mainly concentrated in Western developed countries, and there are few empirical studies in developing countries such as China. Based on POI (point of interest) data and 882 questionnaires collected from 20 neighborhoods in Guangzhou, we employ multilevel linear regression modeling, mediating effect modeling, to explore the path and mechanism of the impact of the built environment on elderly individuals' physical health, especially the mediating effects of physical and social interaction activity. The results show that the number of POIs, the distance to the nearest park and square, and the number of parks and squares are significantly positively correlated with the physical health of the elderly, while the number of bus and subway stations and the distance to the nearest station are significantly negatively correlated. Secondly, physical activity and social networks play a separate role in mediating the effect of the built environment on elderly individuals' physical health. The results enrich the research on the built environment and elderly individuals' health in the context of high-density cities in China and provide some reference basis for actively promoting spatial intervention and cultivating a healthy aging society.

Effects of long-term household air pollution exposure from solid fuel use on depression: Evidence from national longitudinal surveys from 2011 to 2018

Evidence of the effects of long-term household air pollution (HAP) on human mental health is limited. This study aimed to explore the longitudinal relationship between long-term household air pollution exposure from solid fuel use and depression based on nationally representative follow-up dataset. A total of 7005 middle- and old-age adults from the latest four waves (2011, 2013, 2015, and 2018) of China Health and Retirement Longitudinal Study (CHARLS) were involved. The Center for Epidemiologic Studies Depression scale (CES-D 10) was used to measure depressive symptoms and individuals who got more than 12 points were considered to have depression symptoms. We conducted Cox proportional hazards regression models to examine the association between household air pollution and depression in overall population, and subgroup stratified by socio-demographic factors, lifestyle behaviors, chronic diseases, and residential environments. We found long-term household air pollution exposure from solid fuel use was significantly associated with higher depression risk among Chinese older adults (HR 1.27, 95% CI 1.14-1.42 in heating; 1.26, 1.13-1.40 in cooking). Longer duration of household air pollution exposure (1.47, 1.28-1.68 in heating; 1.36, 1.19-1.56 in cooking) and household air pollution from crop residue/wood burning (1.66, 1.41-1.94 in heating; 1.37, 1.23-1.53 in cooking) was correlated with higher depression risk. For subgroups analysis, the effect of household air pollution from solid fuel on depression varied. Compared with those who using clean fuel, older adults living in small size houses or houses with small number rooms had increasing depression risks if they used solid fuel for heating or cooking. Our findings indicate long-term household air pollution exposure from solid fuel use is associated with higher depression risk. Reducing household air pollution by restricting solid fuel use can be effective ways to prevent depression for Chinese older adults and decrease related public health burden.

Do Age-Friendly Rural Communities Affect Quality of Life? A Comparison of Perceptions from Middle-Aged and Older Adults in China

The aging population in rural areas of China faces serious challenges due to urban–rural disparities. In order to improve the active aging of rural older adults, the establishment of age-friendly communities is encouraged. However, globally, the focus is on age-friendly communities in urban areas, not reflecting rural communities. Hence, we addressed the importance of age-friendly rural communities (AFRCs) and aimed to investigate their impact on the quality of life (QoL) of older adults. We examined different perceptions of AFRCs among older adults (aged over 60) and middle-aged people (45–60) in rural communities with questionnaire surveys (n = 470 and 393, respectively). Several statistical methods, such as Chi-squared test, t-test, reliability test, and multiple regression, were adopted to investigate and compare the perceptions of these two. The results indicated that (1) middle-aged people were more satisfied with AFRC components and had a higher QoL than older adults; (2) the QoL of middle-aged people was predicted by housing, accessibility, and outdoor spaces; (3) the QoL of older adults was affected by housing, outdoor spaces, social participation, and public transportation. These findings aid in our understanding of rural communities and the QoL of rural residents. They are helpful for urban planners and policymakers to improve the planning of AFRCs and supplement research on age-friendly communities in rural areas. Practical implementations are proposed for the planning of AFRCs, such as the passive design of residential housing, grouping of community facilities together, and improvement in the hygiene of outdoor spaces in rural areas.