Background Neighbourhood safety is important for older adults’ health, including injury prevention and safety promotion, but there is a dearth of information about this construct in the literature.

Methods During 2014, we conducted a systematic literature review on the associations among identifiable neighbourhood safety factors, health outcomes, and health behaviours of older adults (≥50) in the U.S. using MEDLINE, CINAHL, Embase, SportDis, and Transportation Databases.

Results Of 32 articles identified for our final review, 16 (50%) examined health outcomes, such as health status and the other 16 focused on health behaviours, such as physical activity. Five domains of neighbourhood safety were identified: general neighbourhood safety; crime-related safety; traffic-related safety; fall-related safety; and proxies for safety (e.g., vandalism, graffiti). Although falls are the leading cause of injuries in older adults, fall-related safety was the least frequently addressed safety domain. General neighbourhood safety, traffic-related safety, and proxies for safety appeared most relevant to health behaviours, while crime-related safety was most pertinent to health outcomes, such as mental health and physical function. Traffic-related safety showed more consistent associations for physical activity, while crime-related safety was more consistently associated with walking. We also found that specific measures or constructs of safety were not applied consistently across the different studies making it difficult to compare study findings.

Conclusions This review identified several patterns as well as many important gaps in the existing studies dealing with neighbourhood safety-injury prevention among older adults. We recommend that multi-dimensional neighbourhood safety factors should be considered in establishing location interventions, particularly related to injury prevention and safety promotion, which require further attention in future studies in the U.S. as well as globally.