Towards global age-friendly cities: determining urban features that promote active aging

Ageing in a low-density urban city: transportation mobility as a social equity issue

The purpose of this study was to examine older adults' experiences and perspectives regarding transportation mobility. Using a community-based participatory research approach, residents of Arlington, Texas, age 55 and older, participated in individual interviews (N = 15) or one of six focus groups (N = 45) as part of an overall study about ageing well in a large ethnically diverse city in the United States of America. Thematic analysis was conducted using inductive and deductive qualitative methods and social equity as a sensitising concept. Findings indicate that older adults who are transportation-disadvantaged experience limited access to health care, goods and services and are isolated from familiar lifestyle habits and social networks. Access to affordable, adequate transportation is compromised through social and political forces, which marginalise historically disadvantaged populations. Implications for cross-disciplinary practice and future research on sustainable transportation and policy development are discussed within a social justice and social equity framework.

Older adult social participation and its relationship with health: Rural-urban differences

In an aging world, there is increased need to identify places and characteristics of places that promote health among older adults. This study examines whether there are rural-urban differences in older adult social participation and its relationship with health. Using the 2003 and 2011 waves of the Wisconsin Longitudinal Study (n=3006), I find that older adults living in rural counties are less socially active than their counterparts in more-urban counties. I also find that relationships between social participation and health vary by the type of activity and rural-urban context.

"Why would I want to go out?": Age-related Vision Loss and Social Participation

Social participation, a key determinant of healthy aging, is often negatively impacted by age-related vision loss (ARVL). This grounded theory study aimed to understand social participation as a process negotiated in everyday life by older adults with ARVL. Interviews, audio diaries, and life space maps were used to collect data with 21 older adults in two Ontario cities. Inductive data analysis resulted in a transactional model of the process of negotiating social participation in context. This model depicts how environmental features and resources, skills and abilities, and risks and vulnerabilities transacted with values and priorities to affect if and how social participation occurred within the context of daily life. The findings point to several ways that research and services addressing the social participation of older adults with ARVL need to expand, particularly in relation to environmental features and resources, risk, and the prioritization of independence.

Individual and Neighborhood Factors Associated With Functional Mobility and Falls in Elderly Residents of São Paulo, Brazil: A Multilevel Analysis

Objective: To identify socioeconomic and contextual factors associated with functional mobility and falls in elderly residents of São Paulo, Brazil. Method: We used data from the Health, Well-Being, and Aging ( Saúde, Bem-estare Envelhecimento [SABE]) Study. The dependent variables were falling in the last year and functional mobility impairment. Individual (marital status, race, education, and perception of income sufficiency) and contextual (green area and violence) factors were analyzed by multilevel logistic models. Results: Having 8 or more years of schooling was a protective factor for mobility impairment. Neighborhoods with moderate homicide rate were associated with higher odds of falling. Moderate green spaces were associated with higher odds of falling and lower odds to have mobility impairment for individuals 80 years and older. Discussion: Our findings support the concern that neighborhood characteristics are associated with falls and mobility impairment. Strategies to prevent these outcomes should consider contextual aspects.

Perspectives on the Role and Synergies of Architecture and Social and Built Environment in Enabling Active Healthy Aging

Research has demonstrated that enabling societal and physical infrastructure and personal accommodations enhance healthy and active aging throughout the lifespan. Yet, there is a paucity of research on how to bring together the various disciplines involved in a multidomain synergistic collaboration to create new living environments for aging. This paper aims to explore the key domains of skills and knowledge that need to be considered for a conceptual prototype of an enabling educational process and environments where healthcare professionals, architects, planners, and entrepreneurs may establish a shared theoretical and experiential knowledge base, vocabulary, and implementation strategies, for the creation of the next generation of living communities of active healthy adults, for persons with disabilities and chronic disease conditions. We focus on synergistic, paradigmatic, simple, and practical issues that can be easily upscaled through market mechanisms. This practical and physically concrete approach may also become linked with more elaborate neuroscientific and technologically sophisticated interventions. We examine the domains of knowledge to be included in establishing a learning model that focuses on the still-understudied impact of the benefits toward active and healthy aging, where architects, urban planners, clinicians, and healthcare facility managers are educated toward a synergistic approach at the operational level.

Which Features of the Environment Impact Community Participation of Older Adults? A Systematic Review and Meta-Analysis

Objective: The objective of this study is to identify features of the environment associated with community participation of older adults. Method: A systematic review of studies that examined associations between environment and community participation in older adults was conducted. Environmental features were extracted and grouped using the International Classification of Functioning, Disability, and Health’s environmental categories. Meta-analysis of environmental categories was conducted by calculating combined effect size (ES) estimates. Results: Significant, small to moderate, random ESs were found for six of seven environmental categories: neighborliness (ES = 0.52, 95% confidence interval [CI] = [0.18, 0.87]), social support (ES = 0.38, 95% CI = [0.13, 0.62]), land-use diversity (ES = 0.29, 95% CI = [0.16, 0.42]), transportation (ES = 0.29, 95% CI = [0.15, 0.43]), civil protection (e.g., safety; ES = 0.27, 95% CI = [0.0, 0.54]), and street connectivity/walkability (ES = 0.20, 95% CI = [0.15, 0.26]). Discussion: Community initiatives that address specific features of the social environment and street-level environment may increase community participation of older adults.

An integrative review of the factors related to building age-friendly rural communities

AIM AND OBJECTIVES

To identify the theories and concepts related to building age-friendly rural communities.

BACKGROUND

Global population is rapidly ageing. Creating environments that support active ageing was a catalyst for the World Health Organization to develop Global Age-Friendly Cities guidelines. Although the age-friendly movement has captured the attention of some countries, little is known about the participation of older people in rural settings.

METHOD

An integrative review approach was employed to summarise the research literature on this topic. Using a systematic search strategy, databases including Discover (EBSCO's electronic database system), Web of Science, Scopus, PubMed, CINAHL, PsycINFO, Medline and Google Scholar were searched. Primary, peer-reviewed studies were included if published during 2007-2014 in the English language.

RESULTS

Nine studies were eligible for inclusion. The studies were set predominantly in Canada, with the exception of one from Ireland. The findings were summarised and clustered into main topics which included: theoretical perspectives; geographic and demographic characteristics; collaboration and partnerships; sustainability and capacity; and finally, future research agendas.

CONCLUSIONS

Rural communities are changing rapidly and are becoming increasingly diverse environments. Community characteristics can help or hinder age-friendliness. Importantly, the fundamental starting point for age-friendly initiatives is establishing older peoples' perceptions of their own communities.

RELEVANCE TO CLINICAL PRACTICE

It is important for nurses, working in primary health care settings, to understand the needs of older people in the communities in which they practice. This includes the community characteristics that can be enablers and barriers to older people being able to remain and age within their own communities.

Exploring the meaning of community for older Australians

BACKGROUND/AIM

As the population ages, older adults are being encouraged through policy to remain living in their home and community. Occupational therapists are in a position to support individuals to engage in meaningful occupations, acknowledging the influence of personal and environmental factors on community participation. The purpose of this study was to understand the meaning and experience of community for older Australian adults.

METHODS

A cross-sectional phenomenological research study design was utilised. Convenience and snowball sampling were used to recruit 32 participants with ages ranging from 65 to 94 years living in the south east region of Queensland, Australia. Semi-structured interviews were conducted and thematic analysis was used to explore the participants' responses.

RESULTS

Four final themes were revealed: organised things in the community, community is people, community is what you make of it and the meaning of community is life.

CONCLUSION

The results support that community extends beyond physicality, with personal motivation, the social environment and community involvement identified as important constructs within each of the themes. The findings provide a foundation for future research and occupational therapy practices to support older adults to age in place.

[Current situation of the research on living conditions and health status of elderly people in Spain]

OBJECTIVE

To analyse the dimensions studied with respect to living and health conditions of the non-institutionalised elderly in the scientific literature in Spain.

METHOD

A content analysis based on secondary sources was carried out by literature searches in Pubmed and Embase in Spanish and English. The search strategies combined terms related to older people, health and/or living conditions and with Spain. All studies assessing living and/or health conditions of elderly in Spain were included. Studies analyzing a specific aspect of living or health conditions and those based on institutionalized population were excluded.

RESULTS

A total of 14 studies were considered in the content analysis. The studies are usually local, cross-sectional and data collection is done by direct interview. Variability was observed in the aspects analysed about living and health conditions. All studies included: sociodemographic characteristics, health status and lifestyle habits. Issues related to the status of the out-of home environment are poorly analysed.

CONCLUSIONS

This work allows knowing the dimensions prioritised in the studies carried out to date about health and living conditions in Spain. It also provides key elements for the development of future research aiming to integrate both living and health conditions of elderly population, both aspects closely related.

Socio-Spatial Integration of Older Adults in Four Types of Residential Environments in Israel

The socio-spatial integration of older people in different types of residential environments is a key factor affecting the well-being of older people. This study, which included a convenience sample of 565 participants, examined the socio-spatial integration of older people living in two different regional areas (central and peripheral) and four different residential environments (metropolitan hub, city, and town and rural settlements) in Israel. Willing participants were asked to complete a self-administered questionnaire. Socio-spatial integration was assessed by recognition of their neighbors and sense of belonging to the residential environment. The findings show that older adults who resided in the town and in rural settlements were more socio-spatially integrated in their living environments compared with their counterparts who resided in cities. The best predictors of socio-spatial integration were a combination of personal characteristics and characteristics of the environment (perceived accessibility) except for rural settlements, where none of the variables predicted socio-spatial integration.

Features of home and neighbourhood and the liveability of older South Africans

While older people live in developing countries, little is known about the relative importance of features of their communities in influencing their liveability. We examine components of home and neighbourhood among older South Africans. Linear regression analyses revealed that features of home (basic amenities, household composition, financial status and safety) and neighbourhood (ability to shop for groceries, participate in organizations and feel safe from crime) are significantly associated with life satisfaction. Approaches to liveability that are person-centred and also set within contexts beyond home and neighbourhood are needed to address boundaries between home and neighbourhood; incorporate personal resources into liveability models and import broader environmental contexts such as health and social policy.

Comparing the Age-Friendliness of Different Neighbourhoods Using District Surveys: An Example from Hong Kong

Background

To address the age-friendliness of living environment in cities, the World Health Organization (WHO) launched the “Age-friendly cities” (AFC) initiative in 2005. To date, however, no universal standard tool for assessing age-friendliness of a community has been agreed.

Methodology

Two quantitative studies on AFC conducted in two Hong Kong districts—Sha Tin and Tuen Mun—were compared. A total of 801 residents aged ≥50 years were interviewed using structured questionnaires based on the WHO’s AFC criteria. District-wide differences in age-friendliness were compared on the basis of eight domain scores. Multiple linear regression was used to examine associations with demographic and socio-economic characteristics. The provision of services and amenities was also compared to help explain the difference in domain scores.

Results

Variations in mean domain scores were observed in both districts. Sha Tin showed significantly lower scores in outdoor spaces and buildings, transportation, social participation, respect and social inclusion, civic participation and employment, communication and information, as compared with Tuen Mun. Although a significantly higher score on the housing domain was observed in Sha Tin, differences in community and health services domains were insignificant. Socio-demographic factors, such as age group, gender, area of residence, type of housing, experience of elderly care, employment status, self-rated health and income, were associated with domain scores. However, variations in services and amenities provision appeared not to be strongly associated with district-wide difference in domain scores.

Conclusions

District differences in public opinions towards age-friendly characteristics were observed in this study. Except for two of the eight domains, Sha Tin had significantly lower scores than Tuen Mun. Some socio-demographic indicators seemed predictive to the differences. Paradoxically, Sha Tin had better services and infrastructure and higher socio-economic status, but lower age-friendliness. This warrants detailed research on psychosocial factors that may influence residents’ perceptions of local environments.

Marchabilité des environnements urbains autour des résidences pour personnes âgées de la région de Montréal : application de l’audit MAPPA

Cet article porte sur la marchabilité autour des résidences pour aînés dans le Montréal métropolitain et sur la relation avec la marche qu’entretiennent les aînés habitant dans ces milieux. Des groupes de discussion ont montré que la possibilité de faire des activités ou de rencontrer des gens constitue pour les participants un facteur-clé de leur mobilité quotidienne. Toutefois, les caractéristiques de l’environnement urbain rendent parfois difficiles les déplacements à pied. La marchabilité autour de résidences et de concentrations commerciales proches a été évaluée à l’aide de l’audit environnemental MAPPA. Une typologie de marchabilité construite indique que la grande majorité des segments de rue n’offrent qu’un niveau de sécurité minimal pour les marcheurs âgés. La vie dans ce type de résidence contraint parfois les résidants à se rabattre sur des activités intérieures, et peut éventuellement mener à une certaine forme d’exclusion spatiale freinant leur participation à la vie urbaine.

Developing Age-Friendly Cities and Communities in Australia

Objective: The aim of the study is to present case studies and assess the impact of political, policy, consultative, and research processes used to implement Age Friendly Cities (AFC) initiatives in Australia. Method: A review and interpretation was conducted based on public documents, community consultations, survey analyses, and participant observation. Results: Governments in Australia have drawn on World Health Organization (WHO) concepts to establish AFC initiatives. In Melbourne, state political leadership established Positive Ageing plans that have reinforced local government actions. In Canberra, a baseline survey and an Older Persons Assembly were followed by modest positive ageing plans. In Sydney, a State Ageing Strategy developed a whole-of-government plan that has yet to be incorporated into budget processes. Discussion: AFC initiatives in Australia have had promising and varied starts with some aims to benefit disadvantaged older people. Notwithstanding the potential benefits, AFC influence on mainstream actions of government has been limited by uncertain political commitment and growing fiscal austerity.

Aging and place--neighborhoods and health in a world growing older

The articles in this special issue make it clear that there are interesting and policy-relevant research to identify place-based strategies to improve health and reduce health disparities among older adults. The articles also reveal important areas of future research and policy innovation that are needed related to place and aging.

Mobility Disability in Older Adults: At the Intersection of People and Places

PURPOSE

Mobility disability is associated with poor lower body function among older adults. This study examines whether specific types of neighborhood characteristics moderate that association.

DESIGN AND METHODS

This study is based on a cross-sectional sample of 884 people aged ≥ 65 years identified through service organizations in Alameda County, CA; Cook County, IL; Allegheny County, PA; and Wake and Durham counties, NC. In-person interviews focus on neighborhood characteristics, physical and cognitive function, depression, and walking. Functional capacity is tested using objective measures of lower body strength, balance, and walking speed. Mobility disability, the main study outcome, is measured as self-reported level of difficulty in walking 2-3 neighborhood blocks. Estimates of main and interactive effects are derived from logistic regression models.

RESULTS

Among older adults with poor lower body function, those who report less proximity to goods and services and barriers to walking report more mobility disability than other older adults. In contrast, among older adults with good lower body function, there is a low prevalence of mobility disability and little association between perceptions of the neighborhood and mobility disability.

IMPLICATIONS

In addition to more refined longitudinal studies, this research provides a foundation for innovative place-based rehabilitation and hospital discharge programs for older adults newly diagnosed and treated for chronic health conditions.

Assessing Communities’ Age-Friendliness

The notion of age-friendliness is gaining increasing attention from policy makers and researchers. In this study, we examine the congruence between two types of age-friendly surveys: subjective assessments by community residents versus objective assessments by municipal officials. The study was based on data from 39 mostly rural communities in Manitoba, Canada, in which a municipal official and residents ( M = 25 residents per community) completed a survey to assess age-friendly features in a range of domains, such as transportation and housing. Congruence between the two surveys was generally good, although the municipal official survey consistently overestimated communities’ age-friendliness, relative to residents’ ratings. The findings suggest that a survey completed by municipal officials can provide a reasonable assessment of age-friendliness that may be useful for certain purposes, such as cross-community comparisons. However, some caution is warranted when using only these surveys for community development, as they may not adequately reflect residents’ views.

Understanding the relationships between the physical environment and physical activity in older adults: a systematic review of qualitative studies

BACKGROUND

While physical activity (PA) provides many physical, social, and mental health benefits for older adults, they are the least physically active age group. Ecological models highlight the importance of the physical environment in promoting PA. However, results of previous quantitative research revealed inconsistencies in environmental correlates of older adults' PA that may be explained by methodological issues. Qualitative studies can inform and complement quantitative research on environment-PA relationships by providing insight into how and why the environment influences participants' PA behaviors. The current study aimed to provide a systematic review of qualitative studies exploring the potential impact of the physical environment on older adults' PA behaviors.

METHODS

A systematic search was conducted in databases of various disciplines, including: health, architecture and urban planning, transportation, and interdisciplinary databases. From 3,047 articles identified in the physical activity, initial search, 31 articles published from 1996 to 2012 met all inclusion criteria. An inductive content analysis was performed on the extracted findings to identify emerging environmental elements related to older adults' PA. The identified environmental elements were then grouped by study methodologies [indoor interviews (individual or focus groups) vs spatial methods (photo-voice, observations, walk-along interviews)].

RESULTS

This review provides detailed information about environmental factors that potentially influence older adults' PA behaviors. These factors were categorized into five themes: pedestrian infrastructure, safety, access to amenities, aesthetics, and environmental conditions. Environmental factors especially relevant to older adults (i.e., access to facilities, green open spaces and rest areas) tended to emerge more frequently in studies that combined interviews with spatial qualitative methods.

CONCLUSIONS

Findings showed that qualitative research can provide in-depth information on environmental elements that influence older adults' PA. Future qualitative studies on the physical environment and older adults' PA would benefit from combining interviews with more spatially-oriented methods. Multidisciplinary mixed-methods studies are recommended to establish quantitative relationships complemented with in-depth qualitative information.

Understanding the relationships between the physical environment and physical activity in older adults: a systematic review of qualitative studies

BACKGROUND

While physical activity (PA) provides many physical, social, and mental health benefits for older adults, they are the least physically active age group. Ecological models highlight the importance of the physical environment in promoting PA. However, results of previous quantitative research revealed inconsistencies in environmental correlates of older adults' PA that may be explained by methodological issues. Qualitative studies can inform and complement quantitative research on environment-PA relationships by providing insight into how and why the environment influences participants' PA behaviors. The current study aimed to provide a systematic review of qualitative studies exploring the potential impact of the physical environment on older adults' PA behaviors.

METHODS

A systematic search was conducted in databases of various disciplines, including: health, architecture and urban planning, transportation, and interdisciplinary databases. From 3,047 articles identified in the physical activity, initial search, 31 articles published from 1996 to 2012 met all inclusion criteria. An inductive content analysis was performed on the extracted findings to identify emerging environmental elements related to older adults' PA. The identified environmental elements were then grouped by study methodologies [indoor interviews (individual or focus groups) vs spatial methods (photo-voice, observations, walk-along interviews)].

RESULTS

This review provides detailed information about environmental factors that potentially influence older adults' PA behaviors. These factors were categorized into five themes: pedestrian infrastructure, safety, access to amenities, aesthetics, and environmental conditions. Environmental factors especially relevant to older adults (i.e., access to facilities, green open spaces and rest areas) tended to emerge more frequently in studies that combined interviews with spatial qualitative methods.

CONCLUSIONS

Findings showed that qualitative research can provide in-depth information on environmental elements that influence older adults' PA. Future qualitative studies on the physical environment and older adults' PA would benefit from combining interviews with more spatially-oriented methods. Multidisciplinary mixed-methods studies are recommended to establish quantitative relationships complemented with in-depth qualitative information.

Mobility and out-of-home activities of older people living in suburban environments: ‘Because I'm a driver, I don't have a problem'

Governments are challenged by the need to ensure that ageing populations stay active and engaged as they age. Therefore, it is critical to investigate the role of mobility in older people's engagement in out-of-home activities, and to identify the experiences they have within their communities. This research investigates the use of transportation by older people and its implications for their out-of-home activities within suburban environments. The qualitative, mixed-method approach employs data collection methods which include a daily travel diary (including a questionnaire), Global Positioning System (GPS) tracking and semi-structured interviews with older people living in suburban environments in Brisbane, Australia. Results show that older people are mobile throughout the city, and their car provides them with that opportunity to access desired destinations. This ability to drive allows older people to live independently and to assist others who do not drive, particularly where transport alternatives are not as accessible. The ability to transport goods and other people is a significant advantage of the private car over other transport options. People with no access to private transportation who live in low-density environments are disadvantaged when it comes to participation within the community. Further research is needed to better understand the relationship between transportation and participation within the community environment, to assist policy makers and city and transportation planners to develop strategies for age-friendly environments within the community.

How ‘age-friendly’ are rural communities and what community characteristics are related to age-friendliness? The case of rural Manitoba, Canada

Since the World Health Organization introduced the concept of ‘age-friendly’ communities in 2006, there has been rapidly growing interest in making communities more age-friendly on the part of policy makers world-wide. There is a paucity of research to date, however, that has examined age-friendliness in diverse communities, particularly in rural communities. The main objective of the study reported in this paper was to examine whether age-friendliness varies across community characteristics, such as a population size. The study was based on surveys administered in 56 communities throughout Manitoba, a mid-Western Canadian province, in the context of a needs assessment process for communities that are part of the Age-Friendly Manitoba Initiative. A total of 1,373 individuals completed a survey developed to measure age-friendliness. Domains included the physical environment; housing options; the social environment; opportunities for participation; community supports and health-care services; transportation options; and communication and information. Community characteristics were derived from census data. Multi-level regression analysis indicated that the higher the percentage of residents aged 65 or older, the higher the ratings of age-friendliness overall and, specifically, ratings of the social environment, opportunities for participation, and communication and information. Moreover, small communities located within a census metropolitan area and remote communities in the far north of the province emerged as having the lowest age-friendliness ratings. These findings suggest that communities are generally responsive to the needs of their older residents. That different results were obtained for the various age-friendly domains underscores the importance of considering age-friendliness in a holistic way and measuring it in terms of a range of community features. Our study further highlights the importance of differentiating between degrees of rurality, as different patterns emerged for communities of different sizes and proximity to a larger urban centre.

Exploring the age-friendliness of purpose-built retirement communities: evidence from England

This article contributes to emerging debates around age-friendly environments, providing empirical evidence concerning the relative age-friendliness of purpose-built retirement communities. Adopting a new definition – ‘underpinned by a commitment to respect and social inclusion, an age-friendly community is engaged in a strategic and ongoing process to facilitate active ageing by optimising the community's physical and social environments and its supporting infrastructure’ – the article analyses the age-friendliness of one retirement community in England. The Longitudinal Study of Ageing in a Retirement Community (LARC) encompassed two waves of a survey with residents, interviews and focus groups with stakeholders involved in staffing, managing and designing the community, and other qualitative data collected from residents. Reviewing the different data sources, the article argues that purpose-built retirement communities have the potential to be age-friendly settings but might better involve residents in a regular cycle of planning, implementation, evaluation and continual improvement if they are to facilitate active ageing. In addition, more clarity is needed on how such developments can better fit with the age-friendly agenda, particularly in terms of their capacity to support ageing in place, the accessibility of the wider neighbourhood, opportunities for intergenerational interactions, and the training of staff to work with older people.

Do age-friendly characteristics influence the expectation to age in place? A comparison of low-income and higher income Detroit elders

Currently there is limited evidence linking age-friendly characteristics to outcomes in elders. Using a representative sample of 1,376 adults aged 60 and older living in Detroit, this study examined the association between age-friendly social and physical environmental characteristics and the expectation to age in place, and the potential differences between low- and higher-income elders. Based on U.S. Environmental Protection Agency's (EPA) age-friendly guide, we identified six factors reflecting age-friendly characteristics. Logistic regression models indicated that regardless of income level only neighborhood problems were significantly associated with expecting to age in place. Low-income elders were more likely to expect to age in place than their higher-income counterparts, and it is unclear whether this resulted from a desire to remain in the home or that there is no place else to go. Future research should address the ways in which financial resources affect the choices, expectations, and outcomes of aging in place.

Repensando o fenômeno do envelhecimento na agenda política das cidades: a importância da promoção da mobilidade de pedestres

As cidades confrontam-se atualmente com o duplo desafio de se assumirem cada vez mais enquanto polos de atração e aglutinadores de cidadãos e de concentrarem uma população tendencialmente em envelhecimento. Se é certo que várias orientações têm sido definidas no sentido de fomentar um novo olhar para a relação cidades/envelhecimento, não é menos verdade que a visão preconizada, compreensivelmente holística (abarcando temas como inclusão social, comunicação, emprego, habitação e transportes) carece de alguma especificidade e esclarecimento quanto à qualidade do espaço público e aos fatores que condicionam e geram maior mobilidade por parte dos cidadãos (em geral) e das pessoas idosas (em particular). Num contexto em que se salientam as questões de promoção de atratividade dos espaços enquanto mecanismos indutores de desenvolvimento econômico, por um lado, e em que se verifica a emergência de uma nova visão dos cuidados a prestar às pessoas idosas, designadamente ao apostar na sua permanência na comunidade (ageing in place), por outro, a temática em discussão revela-se de importância acrescida para a formulação de políticas públicas. Centrando-se essencialmente no domínio da organização territorial dos serviços e da mobilidade de pedestres, este texto procura contribuir para o debate, sublinhando sua importância, analisando a bibliografia existente e identificando as principais áreas de intervenção a considerar na construção de uma comunidade que proporcione às pessoas idosas condições que permitam otimizar as capacidades individuais e manter uma qualidade de vida saudável.

Aging in Place in a Retirement Community: 90+ Year Olds

Aging in place, an image of growing old in one's home and maintaining one's daily routine, is desired by most older adults. To identify variables promoting such independent living in the oldest-old, we examined the association between living situation of a population-based cohort of 90+ year olds with health and lifestyle variables. Of 1485 participants, 53% still lived in their home at a retirement community designed to foster wellness. Those living at home tended to be healthier, with smaller proportions having chronic diseases or hospitalizations in the preceding year and a greater proportion having normal functional ability. Dementia was the chronic disease most significantly related to living situation. In addition to not having dementia, not using a wheelchair or bath aid, receiving meals on wheels, and being married were jointly related to living at home. With the help of family and friends and with a medical and social support system, many 90+ year olds can age in place. This is often because they have a caregiving spouse or paid caregiver.

Age-Friendly Environments and Self-Rated Health:

While a number of organizations and government entities have encouraged the development of more “age-friendly” environments, to date there has been limited research linking these environment features to elder outcomes. Using a representative sample of older adults living in Detroit, this study examined the association between age-friendly environment factors and self-rated health. Results indicated that access to health care, social support, and community engagement were each associated with better self-rated health, while neighborhood problems were associated with poorer self-rated health. Moreover, individual-level income and education no longer predicted self-rated health once age-friendly environment factors were taken into account. These findings highlight the need for more research documenting the effects of age-friendly environments, particularly across diverse contexts and populations.

Mobility and aging: new directions for public health action

Optimal mobility, defined as relative ease and freedom of movement in all of its forms, is central to healthy aging. Mobility is a significant consideration for research, practice, and policy in aging and public health. We examined the public health burdens of mobility disability, with a particular focus on leading public health interventions to enhance walking and driving, and the challenges and opportunities for public health action. We propose an integrated mobility agenda, which draws on the lived experience of older adults. New strategies for research, practice, and policy are needed to move beyond categorical promotion programs in walking and driving to establish a comprehensive program to enhance safe mobility in all its forms.

Re-spacing and re-placing gerontology: relationality and affect

This paper describes how space and place have been understood in gerontology as phenomenon that are both physical and social in character, yet are relatively bounded and static. The argument is posed as to how, following recent developments in human geography, a relational approach might be adopted. Involving a twist in current thinking, this would instead understand space and place each as highly permeable, fluid and networked at multiple scales. Moreover, it is proposed that the concept of ‘affect’ might also be insightful, recognising space and place as being relationally configured and performed, possessing a somatically registered energy, intensity and momentum that precedes deep cognition. Three vignettes illustrate the relationalities and affects in the lives and circumstances of older people, and how focusing more explicitly on them would allow for a richer understanding of where and how they live their lives. The paper closes with some thoughts on future theoretical, methodological and disciplinary considerations.

The Active Ageing-concept translated to the residential long-term care

PURPOSE

Active Ageing (AA), as described by the WHO (Active Ageing: a policy framework. World Health Organisation, Geneva 5), is an important concept in gerontology. Since the AA-concept has not been examined in the context of residential long-term care facilities, our study addresses this gap by describing the determinants of AA within this setting.

METHODS

A qualitative study with semi-structured focus groups, followed by a thematic analysis, was conducted. Through purposive sampling, four focus groups of either residents of long-term care facilities (n = 8), children of residents (n = 8), community-dwelling older people (n = 8) and gerontologists (n = 6) were formed.

RESULTS

The thematic analysis yielded nine determinants of AA. Seven correspond to those identified by the WHO: Culture, Behaviour, Psychological Factors, Physical Environment, Social Environment, Economic Characteristics and Health and Social Care. Two new determinants were identified: Meaningful Leisure and Participation. The determinant Participation is seen as crucial to AA in residential care.

CONCLUSION

This study points to a more extensive set of determinants of AA than those identified by the WHO (Active Ageing: a policy framework. World Health Organisation, Geneva 5). Staff of long-term care facilities can make use of these determinants to promote AA in their residents.

Social participation and healthy ageing: a neglected, significant protective factor for chronic non communicable conditions

BACKGROUND

Low and middle income countries are ageing at a much faster rate than richer countries, especially in Asia. This is happening at a time of globalisation, migration, urbanisation, and smaller families. Older people make significant contributions to their families and communities, but this is often undermined by chronic disease and preventable disability. Social participation can help to protect against morbidity and mortality. We argue that social participation deserves much greater attention as a protective factor, and that older people can play a useful role in the prevention and management of chronic conditions. We present, as an example, a low-cost, sustainable strategy that has increased social participation among elders in Sri Lanka.

DISCUSSION

Current international policy initiatives to address the increasing prevalence of non-communicable chronic diseases are focused on cardiovascular disease, diabetes, respiratory disease and cancers, responsible for much premature mortality. Interventions to modify their shared risk factors of high salt and fat diets, inactivity, smoking and alcohol use are advocated. But older people also suffer chronic conditions that primarily affect quality of life, and have a wider range of risk factors. There is strong epidemiological and physiological evidence that social isolation, in particular, is as important a risk factor for chronic diseases as the 'lifestyle' risk factors, yet it is currently neglected. There are useful experiences of inexpensive and sustainable strategies to improve social participation among older people in low and lower middle income countries. Our experience with forming Elders' Clubs with retired tea estate workers in Sri Lanka suggests many benefits, including social support and participation, inter-generational contact, a collective voice, and facilitated access to health promotion activities, and to health care and social welfare services.

SUMMARY

Policies to address the increase in chronic non-communicable diseases should include consideration of healthy ageing, conditions that affect quality of life, and strategies to increase social participation. There are useful examples showing that it is feasible to catalyse the formation of Elders' Clubs or older people's associations which become self-sustaining, promote social participation, and improve health and well-being of elders and their families.