gms | German Medical Science

Background: Major depressive disorder, dementia, anxiety disorders, and substance abuse affect a substantial part of the European older population. Over 70% of Europeans reside in cities, and this percentage will increase in the next decades. Urbanization and ageing have enormous implications for public mental health. Cities pose major challenges for older citizens, but also offer opportunities for the design of policies, clinical and public health interventions that promote mental health.

Research question: Which opportunities are offered by the urban environment to support the promotion of mental wellbeing and cognitive function of older individuals in Europe?

Methods: The MINDMAP consortium (2016-2019) will bring together longitudinal studies across cities in Europe, the US and Canada to disentangle the causal pathways and multi-level interactions between the urban environment and the individual determinants of mental wellbeing in older age. The project will examine the causes of variation in mental well-being and disorders in old age both within as well as between cities and identify national and urban policies for the prevention and early diagnosis of mental conditions and disorders of older people by addressing the following work packages (WP):

• WP 1 (PI): Project coordination, relying on the expertise in leading successful European projects
• WP 2: Development of a conceptual model linking the urban environment to mental health and cognitive function in the context of ageing, and the construction of a data platform of 10 international harmonized longitudinal urban cohorts of ageing covering 16 cities in Europe, Canada and the US
• WP 3, WP 4: Impact of urban environmental characteristics on register-based mental health and cognitive health outcomes, including the years lived without mental health disorders, and reported morbidity
• WP 5: Harmonization and analysis of data on biomarkers of mental health across urban cohorts and the assessment of the interaction between genes and the urban environment, including epigenetic analyses
• WP 6, WP 7, WP 8: Pathways linking the urban environment to mental health and cognition via lifestyle behaviour (WP 6), social influences (WP7) and mobility patterns in the built environment (WP 8)
• WP 9: Linkage between the urban environment and the geriatric functioning continuum to identify target groups for interventions in the urban environment
• WP 10: Analysis of the impact of ‘health-in-all’ and mental health policies on the mental dimension of healthy ageing
• WP 11: Development of an integrative agent-based model to simulate the impact of policies and prevention strategies on mental health in urban environments
• WP 12: Dissemination and communication strategy for translational actions and exchange with European, national and regional policy makers and stakeholders in mental health policy

Expected results: The German MINDMAP partner (WP9) will adopt the geriatric perspective by acknowledging mental health and cognitive functioning as essential elements of the dynamic process of frailty. An understanding of the mental dimension of ageing requires incorporating the reciprocal relationships between mental and physical frailty. Early disturbances in mental and cognitive functioning can influence physical function and mobility, a major prerequisite of independence; at the same time, physical frailty predicts the onset and course of late-life depression. These findings highlight the importance of preventing mental health disorders as a strategy to reduce frailty in older age. MINDMAP stresses the importance of early detection of pre-clinical stages of frailty, including mental aspects, as a core component of functional competence among older persons. We will apply the LUCAS Functional Ability Index, an innovative conceptual approach and screening tool to identify individuals in the geriatric functioning continuum, thereby considering both resources and risk factors. This index was developed in the Longitudinal Urban Cohort Ageing Study, LUCAS and will enable the identification of target groups (within the heterogeneous population of older individuals) for early identification and targeted prevention, and for personalized clinical interventions, within networks of mental health care-service provision.

Discussion and practical implications: Knowledge will significantly contribute to establish future-proof preventive strategies in urban settings to promote the mental dimension of healthy ageing, lower the negative impact of mental disorders on co-morbidities, and maintain physical and mental capacity (WHO 2015) in old age.

Funding: MINDMAP is supported by the European Union Commission Horizon2020 Programme under grant agreement no 667661. LUCAS was funded by the Bundesministerium für Bildung und Forschung (BMBF) Fkz: LUCASI: 01ET0708, LUCASII: 01ET1002A, LUCASIII / PROLONG HEALTH: 01EL1407.