Direct and Indirect Pathways of the Built Environment on Older Adult Health: A Bibliometric Analysis and Thematic Synthesis

Population aging and urbanization highlighted the importance of built environments that support health in later life. This study integrates bibliometric analysis and thematic synthesis to characterize research on the built environment and older adult health and organize evidence on potential health pathways. Bibliometric analysis using CiteSpace covers 2411 publications from the Web of Science Core Collection and China National Knowledge Infrastructure published between 2001 and 2025, comprising 1992 English-language and 419 Chinese-language records. Thematic synthesis draws on selected empirical studies to examine environmental attributes, proposed pathways, and health outcomes. Bibliometric findings identify physical activity, walking, and neighborhood environments as central themes, alongside mental health, quality of life, and community-related concerns.The thematic synthesis organizes the evidence into two complementary pathways: direct physiological exposure, including air pollution and thermal stress, and indirect processes involving physical activity, environmental perception, social interaction, and service use. Density-related evidence suggests that resource proximity, environmental pressure, and mobility demands may shape these relationships across urban settings. The resulting framework highlights the need to consider exposure conditions, practical accessibility, and opportunities for participation jointly. It informs age-friendly planning by linking exposure reduction with accessible daily destinations and supportive public spaces, while recognizing differences in older adults’ capabilities and urban contexts.