The Impact of Visual Landscape Environment in Cold-Region Communities on Blood Pressure and Emotion of the Elderly: A Gender-Differentiated Study Based on Eye-Tracking and Hierarchical Linear Models

Global aging is accelerating, with the proportion of the population aged 60 and above projected to reach 22% by 2050. In cold-region communities, the visual landscape environment is closely associated with the health of older adults, particularly showing associations with blood pressure (BP) and emotion states. However, associations between these factors across different landscape spaces and potential gender differences remain underexplored. This study utilized eye-tracking experiments to collect visual attention data from older adults in three types of cold-region community spaces: inter-building spaces, walkways and squares. The ground, buildings, trees, lawn, and the sky were identified as the primary Areas of Interest (AOIs). The Profile of Mood States (POMS) scale was used to assess emotion during walking experiments, revealing suggestive gender–environment interaction characteristics. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) were measured, and a Mann–Whitney U test indicated that DBP in community squares exhibited significant environmental dependency (U = 114.5, p = 0.004, r = 0.44). Hierarchical Linear Models (HLMs) revealed that, after controlling for individual differences, the number of fixation points on ground was independently associated (i.e., independent of measured individual characteristics) with elevated SBP (γ=0.31, p=0.011), while fixation on trees was associated with reduced SBP (γ=−0.24, p=0.018). Furthermore, gender moderation effects were observed: the association between ground fixation and SBP was stronger in females (γ=0.18, p=0.022), whereas the association between sports facilities and DBP was stronger in males (γ=0.29, p=0.009). Based on these findings, evidence-based design strategies are proposed, including the optimization of ground safety, gender-differentiated planting configurations, and targeted layouts for sports facilities. These results provide empirical support for age-friendly community design in cold regions.