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Matsumoto H, Takaoka M, Yamamoto-Mitani N, Igarashi A. Development of Four-Item Attitudes toward People Living with Dementia Scale for population surveys. Psychogeriatrics 2024; 24:1120-1131. [PMID: 39039352 DOI: 10.1111/psyg.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND This study developed a short version of a scale measuring attitudes toward people living with dementia, the Four-Item Attitudes toward People Living with Dementia Scale (APDS4), that could be included in a large population survey. METHODS We used three datasets from Japan: a web panel survey, a community-based mail survey, and data from a randomised controlled trial on dementia education. The original scale used was the Attitudes toward People Living with Dementia Scale developed by Kim and Kuroda. Test-retest reliability and item response theory analyses were used to reduce the number of items. The reliability, internal consistency, validity, and responsiveness of the short version were evaluated. RESULTS Six items with low test-retest reliability and four items with low discrimination parameters were removed from the 14-item scale. The APDS4, consisting of four items, had test-retest reliability and internal consistency comparable to those of the original scale. Confirmatory factor analysis indicated that the APDS4 fit a unidimensional model. The validity of the APDS4 was confirmed by significant associations between the APDS4 scores and the original scale scores, knowledge of dementia, helping behaviour intentions toward people living with dementia, helping behaviour experience, attending the Dementia Supporter Training Course, and engagement in healthcare jobs. In a randomised controlled trial dataset, the APDS4 was more responsive to educational interventions than the original scale. CONCLUSION The shortened APDS4 was established as a reliable, validated, and responsive scale. This scale can be used efficiently in population surveys to evaluate dementia-friendly initiatives at the community level.
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Affiliation(s)
- Hiroshige Matsumoto
- Department of Community Health Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyō, Japan
| | - Manami Takaoka
- Department of Gerontological Home Care and Long-Term Care Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyō, Japan
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-Term Care Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyō, Japan
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long-Term Care Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyō, Japan
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Hérick de Sá T, Sudsataya D, Fry A, Salehi N, Katiki A, Mcleod M, Rathmell G, Cylus J, Lafortune L, Buffel T, Doran P, Officer A, Naci H. The impact of transport, housing, and urban development interventions on older adults' mobility: A systematic review of experimental and quasi-experimental studies. JOURNAL OF TRANSPORT & HEALTH 2024; 38:101859. [PMID: 39328280 PMCID: PMC11422292 DOI: 10.1016/j.jth.2024.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/21/2024] [Accepted: 06/10/2024] [Indexed: 09/28/2024]
Abstract
Background Age-friendly cities and communities aim to enhance and preserve the functional abilities of older adults. This systematic review assesses the impact of interventions in transportation, housing, and urban development on the mobility of older adults. Methods We systematically searched MEDLINE, Embase, CINAHL, Scopus, PsycINFO, and SocINDEX up to July 2022 to identify studies that evaluated the impact of transportation, housing, and urban development interventions on older adults' mobility. Only randomised controlled trials and quasi-experimental studies with control groups were included to establish a causal relationship between interventions and mobility outcomes. Findings We included a total of 15 studies, of which six were randomised controlled trials. Included studies were conducted in high-income settings and employed diverse metrics to assess mobility outcomes. Among housing interventions, three studies examined the impact of assistive technology within home environments for frail older adults. Two of these interventions maintained functional status without improvement, while the third showed a significant decline in outcomes, with the control group faring even worse. Public transport interventions, focused on enhancing mobility through educational initiatives and policy revisions, consistently produced positive outcomes. Interventions related to driving training for older adults, including in-class and on-road assessments, demonstrated beneficial effects. Results from studies evaluating urban design interventions were more varied, with some enhancing mobility by making public spaces more accessible for older adults and others yielding mixed results following infrastructure changes. Interpretation Interventions in the built environments of older adults, specifically targeting transportation, housing and urban development, have the potential to enhance mobility and related outcomes according to rigorously designed quantitative evaluations. Due to heterogeneity in how mobility is conceptualised in the literature, greater harmonisation in measurement of mobility would help us understand how the social and built environment contribute to maintaining and improving mobility in older adults. Funding World Health Organization.
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Affiliation(s)
- Thiago Hérick de Sá
- Demographic Change and Healthy Ageing Unit, Department for Social Determinants of Health, World Health Organization, Switzerland
| | - Daniele Sudsataya
- Department of Health Policy, London School of Economics and Political Science, UK
| | - Andra Fry
- LSE Library, London School of Economics and Political Science, UK
| | - Nazak Salehi
- Department of Health Policy, London School of Economics and Political Science, UK
| | - Aishwarya Katiki
- Department of Health Policy, London School of Economics and Political Science, UK
| | - Megan Mcleod
- Department of Health Policy, London School of Economics and Political Science, UK
| | - Greg Rathmell
- Department of Health Policy, London School of Economics and Political Science, UK
| | - Jon Cylus
- European Observatory on Health Systems and Policies, UK
| | | | - Tine Buffel
- Manchester Urban Ageing Research Group, University of Manchester, UK
| | - Patty Doran
- Manchester Urban Ageing Research Group, University of Manchester, UK
| | - Alana Officer
- Demographic Change and Healthy Ageing Unit, Department for Social Determinants of Health, World Health Organization, Switzerland
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, UK
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Han J, Ma H, Wang M, Li J. Construction and improvement strategies of an age-friendly evaluation system for public spaces in affordable housing communities: a case study of Shenzhen. Front Public Health 2024; 12:1399852. [PMID: 39091526 PMCID: PMC11293305 DOI: 10.3389/fpubh.2024.1399852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024] Open
Abstract
Characterized by early construction periods, as the concentration of low-income populations and a high level of aging, affordable housing communities face prominent challenges such as incongruence between age-friendly construction and the needs of the older adult population. It is urgent to provide pathways and tools for identifying age-friendly issues and optimizing the built environment. The systematic evaluation of age-friendly communities serves as the foundation for implementing intervention measures by developers. Therefore, the construction of a scientifically systematic evaluation system becomes an objective necessity for age-friendly community development. Building upon existing research, this study systematically outlines the subjects, processes, methods, and content involved in constructing an age-friendly community evaluation system. By the methods such as factor analysis and analytical hierarchy process (AHP), the study focuses on the public spaces of affordable housing communities in Shenzhen as a case for constructing an age-friendly evaluation system. The empirical validation of the indicator system is conducted, and the application results are resulted into concrete improvement recommendations and action items, aiming to provide a practical, quantitative tool for community age-friendliness evaluation. The study reveals that adhering to an effective evaluation process, exploring collaborations among multiple stakeholders, determining hierarchical evaluation criteria, and adopting diversified evaluation methods are key to constructing an age-friendly evaluation system for communities. Additionally, the specificity of the evaluation system is influenced by regional demographic structures, policy backgrounds, and the built environment.
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Affiliation(s)
- Jiwen Han
- School of Architecture, Southeast University, Nanjing, China
- School of Architecture, Harbin Institute of Technology, Shenzhen, Shenzhen, China
| | - Hang Ma
- School of Architecture, Harbin Institute of Technology, Shenzhen, Shenzhen, China
| | - Mohan Wang
- School of Architecture, Harbin Institute of Technology, Shenzhen, Shenzhen, China
| | - Jinqi Li
- School of Architecture, Harbin Institute of Technology, Shenzhen, Shenzhen, China
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Chui CHK, Lu S, Chan OF, Cheung JCS, Guo Y, Liu Y, Lum TYS. Universities as Intermediary Organizations: Catalyzing the Construction of an Age-Friendly City in Hong Kong. Innov Aging 2023; 7:igad016. [PMID: 37038553 PMCID: PMC10082544 DOI: 10.1093/geroni/igad016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Indexed: 02/23/2023] Open
Abstract
Background and Objectives The construction of an Age-Friendly City (AFC) requires active contribution from relevant interest groups including older adults, nonprofit organizations, and policy-makers. However, given that relevant interest groups may have limited resources, knowledge, and skills, as well as unique contextual factors, they often require help from intermediary organizations-actors that aim to build interest groups' capabilities. Our objectives were to examine the functions of universities, as an example of intermediary organizations, in facilitating the construction of an AFC, and identify critical factors that enable intermediary organizations to perform their functions. Research Design and Methods We conducted three focus groups and one individual interview with multiple interest groups including older adults and social workers from nonprofit organizations and local government involved in a 6-year citywide AFC project in Hong Kong. Participants were asked to share their views on the role of universities in relation to their own experiences and roles in the project. Data generated from the interviews were analyzed using thematic analysis. Results Four themes pertinent to the functions of universities in facilitating development were identified: facilitating cross-sector collaborations, knowledge diffusion, interest-group building, and mediating divergent interests. We also found that neutrality and reputability are key characteristics for intermediary organizations to wield sufficient legitimacy to perform their functions efficiently. Discussion and Implications Findings underscore the important yet overlooked role of intermediary organizations in bridging and mediating different interest groups to facilitate AFC development. We advance gerontological scholarship by providing insights into the theoretical mechanisms and practice implications for intermediary organizations in fostering an AFC.
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Affiliation(s)
- Cheryl Hiu-Kwan Chui
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Shiyu Lu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - On Fung Chan
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Johnson Chun-Sing Cheung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Yingqi Guo
- Department of Social Work, Hong Kong Baptist University, Hong Kong, China
| | - Yuqi Liu
- Department of Urban Planning, School of Architecture, South China University of Technology, Guangzhou, China
| | - Terry Y S Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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McLaughlin D, Hasson F, Reid J, Brazil K, Rutherford L, Stone C, van der Steen JT, Ballentine J. Evaluating a partnership model of hospice enabled dementia care: A three-phased monitoring, focus group and interview study. Palliat Med 2022; 36:1351-1363. [PMID: 36065098 PMCID: PMC9606481 DOI: 10.1177/02692163221116763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND People with dementia and their caregivers often lack equitable access to hospice care which is a concern internationally. Domains of best practice in palliative care for this population exist and hospices are urged to become dementia friendly. AIM This study aimed to evaluate the model of 'Hospice Enabled Dementia Partnership' mapped to international domains of best practice. DESIGN Three-phased monitoring, group interview and individual interview study using a formative evaluation framework. SETTINGPARTICIPANTS The partnership model was a collaboration between a large specialist palliative care hospice, a dementia charity and a Health Care Trust in the United Kingdom. Service documents were subjected to documentary review of monitoring activity and key indicators of service success. Group interviews and individual interviews took place with family carers (n = 12), health care professionals involved in delivering the service (n = 32) and senior professionals (n = 5) responsible for service commissioning in palliative or dementia care. RESULTS One hundred people with dementia were referred to the service between May 2016 and December 2017. Thirty-eight of the 42 people who died, achieved their preferred place of care and died at home. Four themes were derived from the data 'Impact of Dementia', 'Value of the Service', 'Information and Learning Needs' and 'Working in Partnership'. CONCLUSIONS Positive outcomes resulted from this best practice model; achievement of preferred place of care and death at home, dual benefits of therapies for patients and families and partnership in cross working and learning between services. Replication of this model should be considered internationally.
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Affiliation(s)
- Dorry McLaughlin
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen’s University, Belfast, Northern Ireland
| | - Felicity Hasson
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, Northern Ireland
| | - Joanne Reid
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen’s University, Belfast, Northern Ireland
| | - Kevin Brazil
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen’s University, Belfast, Northern Ireland
| | - Lesley Rutherford
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen’s University, Belfast, Northern Ireland
- Belfast Health and Social Care Trust, Marie Curie Hospice, Belfast, Northern Ireland
| | - Carol Stone
- Belfast Health and Social Care Trust, Marie Curie Hospice, Belfast, Northern Ireland
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Buckner S, Lafortune L, Darlington N, Dickinson A, Killett A, Mathie E, Mayrhofer A, Woodward M, Goodman C. A suite of evaluation resources for Dementia Friendly Communities: Development and guidance for use. DEMENTIA 2022; 21:2381-2401. [PMID: 36067141 PMCID: PMC9583293 DOI: 10.1177/14713012221106634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objectives In the context of a growing number of dementia friendly communities (DFCs)
globally, a need remains for robust evaluation, and for tools to capture
relevant evidence. This paper reports the development of a suite of
evaluation resources for DFCs through a national study in England. Methods Fieldwork took place in six diverse case study sites across England. A mixed
methods design was adopted that entailed documentary analysis, focus groups,
interviews, observations, and a survey. Participants were people affected by
dementia and practice-based stakeholders. A national stakeholder workshop
was held to obtain input beyond the research sites. A workshop at the end of
the study served to check the resonance of the findings and emerging outputs
with stakeholders from the case study DFCs. Results The study had three key outputs for the evaluation of DFCs: First, an
evaluation framework that highlights thematic areas to be considered in
evaluating DFCs. Second, a Theory of Change that presents inputs into a DFC
and short, medium and longer term outcomes. Third, a matrix for assessing a
DFC’s degree of maturity, which enables a sense of the kinds of outcomes a
DFC might realistically aspire to. These three outputs form a suite of
interlinking and complementary evaluation resources for DFCs. Conclusions The study has contributed evidence-based resources for monitoring and
evaluation that complement existing frameworks. They can be applied to
arrive at a detailed assessment of how well a DFC works for people affected
by dementia, and at insights into the underlying factors that can guide
future policy and practice.
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Affiliation(s)
- Stefanie Buckner
- Cambridge, Public Health, 2152University of Cambridge, Cambridge, UK
| | - Louise Lafortune
- Cambridge, Public Health, 2152University of Cambridge, Cambridge, UK
| | - Nicole Darlington
- Centre for Research in Public Health and Community, 3769University of Hertfordshire, Hatfield, UK
| | - Angela Dickinson
- Centre for Research in Public Health and Community, 3769University of Hertfordshire, Hatfield, UK
| | - Anne Killett
- Faculty of Medicine and Health Sciences, 6106University of East Anglia, Norwich, UK
| | - Elspeth Mathie
- Centre for Research in Public Health and Community, 3769University of Hertfordshire, Hatfield, UK
| | - Andrea Mayrhofer
- Population Health Sciences Institute, 5994Newcastle University, Newcastle upon Tyne, UK
| | - Michael Woodward
- Faculty of Medicine and Health Sciences, 6106University of East Anglia, Norwich, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community, 3769University of Hertfordshire, Hatfield, UK
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Mathie E, Antony A, Killett A, Darlington N, Buckner S, Lafortune L, Mayrhofer A, Dickinson A, Woodward M, Goodman C. Dementia-friendly communities: The involvement of people living with dementia. DEMENTIA 2022; 21:1250-1269. [PMID: 35088605 PMCID: PMC9109212 DOI: 10.1177/14713012211073200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dementia Friendly Communities (DFCs) offer an approach to community engagement to improve the lives of people living with dementia and their family supporters. The involvement of those living with dementia is key to creating successful DFCs. This paper examines how people affected by dementia were involved in developing and designing DFCs in England, and the impact of their involvement. METHODS This study used a mixed method case study design in six DFCs in England. Data collection involved documentary analysis, a survey, and interviews and focus groups with service providers and people living with dementia and their supporters. FINDINGS All six DFCs aspired to involve people living with dementia and their family supporters, but often relied on a small number of people living with dementia. The range of involvement activities in DFCs included Steering Group meetings, wider public consultations, and enabling feedback through data collection methods such as surveys and 'ad hoc' conversations. Organisations within the DFCs with experience of public consultation offered structured opportunities for involvement. There was no evidence of people living with dementia initiating or co-leading the organisation, its direction and/or the activities of the DFCs. CONCLUSION The involvement of people living with dementia in DFCs went beyond rhetoric, with some evidence of context sensitive and meaningful participation. Approaches towards involvement should focus on involvement in strategic planning, and on harnessing expertise in delivering different involvement activities to optimise participation of a greater breadth of people living with dementia. Engagement with local organisations who work with, and for, people living with dementia, and dedicating the resources needed for involvement work, are crucial for creating DFCs. The success of DFCs are determined by how the needs of people living with dementia are identified, discussed and reviewed by those within the community who are most affected.
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Affiliation(s)
- Elspeth Mathie
- 3769University of Hertfordshire, Centre for Research in Public Health and Community Care, College Lane, Hatfield, Hertfordshire, UK
| | - Arthur Antony
- 6106University of East Anglia, Faculty of Medicine and Health Sciences Norwich, Norfolk, UK
| | - Anne Killett
- 6106University of East Anglia, Faculty of Medicine and Health Sciences Norwich, Norfolk, UK
| | - Nicole Darlington
- 8018University of Hertfordshire, Centre for Research in Public Health and Community Care, College Lane, Hatfield, UK
| | - Stefanie Buckner
- 2152University of Cambridge, Cambridge Public Health, Forvie Site, Robinson Way, Cambridge, UK
| | - Louise Lafortune
- 2152University of Cambridge, Cambridge Public Health, Forvie Site, Robinson Way, Cambridge, UK
| | - Andrea Mayrhofer
- Newcastle University, Population Health Sciences Institute, Newcastle Upon Tyne, UK
| | - Angela Dickinson
- University of Hertfordshire, Centre for Research in Public Health and Community Care, Hatfield, Hertfordshire, UK
| | - Michael Woodward
- University of East Anglia, Faculty of Medicine and Health Sciences Norwich, Norfolk, UK
| | - Claire Goodman
- University of Hertfordshire, Centre for Research in Public Health and Community Care, College Lane, UK
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Domènech-Abella J, Switsers L, Mundó J, Dierckx E, Dury S, De Donder L. The association between perceived social and physical environment and mental health among older adults: mediating effects of loneliness. Aging Ment Health 2021; 25:962-968. [PMID: 32067471 DOI: 10.1080/13607863.2020.1727853] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Despite growing interest in the impact of physical and social environment on mental health, data are lacking on the potential mediating effects of loneliness. We examined it in the association of several social and physical environmental characteristics with mental health among older adults in three municipalities in Flanders (Belgium).Methods: A total of 869 people aged 60 and over were interviewed. Loneliness was assessed through the De Jong Gierveld short scales for emotional and social loneliness. Social participation and social cohesion were assessed following the Neighborhood scales whereas physical environment characteristics were selected from the Neighborhood Environment Walkability Scale. Mental health was assessed through subscale psychological frailty of the Comprehensive Frailty Assessment Instrument plus (CFAI-plus). Linear regression models, including mediation analysis, were used to analyze the survey data.Results: After adjusting for individual characteristics, physical and social environment factors were significantly related to mental health with the significant mediation of emotional and social loneliness. Percentages mediated by both dimensions together were 61% for social cohesion, 43% for social participation, 35% for safety and 25% for mobility. Compared with social loneliness, emotional loneliness was a stronger mediating factor, particularly for mobility and safety. No significant associations between traffic density or basic service availability and mental health were found.Discussion: Improving the social and physical environment might result in a reduction in the prevalence of loneliness and in consequent improvement of mental health among older adults. Special attention should be paid to different types of loneliness.
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Affiliation(s)
- Joan Domènech-Abella
- Department of Sociology, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Lise Switsers
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Jordi Mundó
- Department of Sociology, Universitat de Barcelona, Barcelona, Spain
| | - Eva Dierckx
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Alexian Psychiatric Hospital, Tienen, Belgium
| | - Sarah Dury
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Liesbeth De Donder
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Kim K, Buckley T, Burnette D, Kim S, Cho S. Measurement Indicators of Age-Friendly Communities: Findings from the AARP Age-Friendly Community Survey. THE GERONTOLOGIST 2021; 62:e17-e27. [PMID: 33909074 PMCID: PMC8759505 DOI: 10.1093/geront/gnab055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cities and counties worldwide have adopted the concept of "age-friendly communities." These communities aspire to promote older adults' well-being by providing a safe, affordable built environment and a social environment that encourages their participation. A major limitation in this field is the lack of valid and reliable measures that capture the complex dimensionality and dynamic nature of the aging-environment interface. RESEARCH DESIGN AND METHODS This study uses data from the AARP 2016 Age-Friendly Community Surveys (N=3,652 adults ages 65 and older). The survey includes 62 indicators of age-friendliness, e g., outdoor spaces, transportation, housing, social participation, and community and health services. We randomly split the sample into two equal subsamples for confirmatory factor analysis (CFA) and structural equation modeling (SEM). RESULTS CFA results indicated that both the five-factor model and the second-order factor model adequately fit the data. In the SEM five-factor model, outdoor space (β=.134; p=.017), social participation (β=.307; p<.001), and community and health services (β=-.149; p=.008) were associated with self-rated health, the outcome of interest. The path coefficients of housing and transportation were not significant. In the second-order factor model, people who lived in more age-friendly communities reported better self-rated health (β=.295; p<.001). DISCUSSION AND IMPLICATIONS Our findings show that the Age-Friendly Community Survey measures demonstrate reliability and concurrent validity. To promote older adults' well-being, practitioners, policymakers, and researchers should focus on improving their built and social environments. They can use these measures for short- and long-term planning, monitoring, and evaluating age-friendly community initiatives.
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Affiliation(s)
- Kyeongmo Kim
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Tommy Buckley
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Denise Burnette
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Seon Kim
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sunghwan Cho
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
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van Hoof J, Marston HR. Age-Friendly Cities and Communities: State of the Art and Future Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041644. [PMID: 33572181 PMCID: PMC7914698 DOI: 10.3390/ijerph18041644] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Joost van Hoof
- Faculty of Social Work & Education, The Hague University of Applied Sciences, 2521 EN Den Haag, The Netherlands
- Faculty of Environmental Engineering and Geodesy, Institute of Spatial Management, Wrocław University of Environmental and Life Sciences, 50-357 Wrocław, Poland
- Correspondence: ; Tel.: +31-6-23381404
| | - Hannah R. Marston
- Health & Wellbeing Strategic Research Area, School of Health, Wellbeing & Social Care, The Open University, Buckinghamshire MK7 6HH, UK;
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Physical Environment vs. Social Environment: What Factors of Age-Friendliness Predict Subjective Well-Being in Men and Women? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020798. [PMID: 33477788 PMCID: PMC7832315 DOI: 10.3390/ijerph18020798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022]
Abstract
“Age-Friendly Cities and Communities” is an initiative launched by the WHO in 2007 that has spread to more than 1000 cities and communities around the world. This initiative is based on an integrated physical and social environment for older people, and a model of participatory, collaborative governance. An enabling social environment setting is just as important as material conditions in determining well-being in later life. The objective of this study is to analyze the interaction between age-friendliness (physical and social) and subjective well-being in women and men aged 55 and over in the Basque Country. The methodology was based on a survey of a representative sample (n = 2469 individuals). In order to know the predictive power of age-friendliness over subjective well-being, linear regression models separated by gender were constructed. The predictive models of age-friendliness are composed by different variables for men and women. In both cases, the physical environment variables do not remain in the final model. Among the predictors of well-being in men, the coexistence stands out as a safety and support network. In women, the neighborhood has proved to be a very important resource. The conclusions of this study contribute to literature and interventions promoting more effective strategies that enhance older people well-being, considering the gender perspective.
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Developing Age-Friendly Cities and Communities: Eleven Case Studies from around the World. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010133. [PMID: 33375466 PMCID: PMC7795502 DOI: 10.3390/ijerph18010133] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/25/2022]
Abstract
Developing age-friendly cities and communities has become a key part of policies aimed at improving the quality of life of older people in urban areas. The World Health Organization has been especially important in driving the ‘age-friendly’ agenda, notably through its Global Network of Age-Friendly Cities and Communities, connecting 1114 (2020 figure) cities and communities worldwide. Despite the expansion and achievements of the Network over the last decade, little is known about the progress made by cities developing this work around the world. This article addresses this research gap by comparing the experience of eleven cities located in eleven countries. Using a multiple case study approach, the study explores the key goals, achievements, and challenges faced by local age-friendly programs and identifies four priorities the age-friendly movement should consider to further its development: (1) changing the perception of older age; (2) involving key actors in age-friendly efforts; (3) responding to the (diverse) needs of older people; and (4) improving the planning and delivery of age-friendly programs. The article concludes by discussing the research and policy implications of these findings for the age-friendly movement.
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Ronzi S, Orton L, Buckner S, Bruce N, Pope D. How is Respect and Social Inclusion Conceptualised by Older Adults in an Aspiring Age-Friendly City? A Photovoice Study in the North-West of England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249246. [PMID: 33321914 PMCID: PMC7764117 DOI: 10.3390/ijerph17249246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/03/2022]
Abstract
The World Health Organisation (WHO) Global Age-Friendly Cities (AFC) Guide classifies key characteristics of an AFC according to eight domains. Whilst much age-friendly practice and research have focused on domains of the physical environment, those related to the social environment have received less attention. Using a Photovoice methodology within a Community-Based Participatory Research approach, our study draws on photographs, interviews and focus groups among 26 older Liverpool residents (60+ years) to explore how the city promotes respect and social inclusion (a core WHO AFC domain). Being involved in this photovoice study allowed older adults across four contrasting neighbourhoods to communicate their perspectives directly to Liverpool’s policymakers, service providers and third sector organisations. This paper provides novel insights into how: (i) respect and social inclusion are shaped by aspects of both physical and social environment, and (ii) the accessibility, affordability and sociability of physical spaces and wider social processes (e.g., neighbourhood fragmentation) contributed to or hindered participants’ health, wellbeing, intergenerational relationships and feelings of inclusion and connection. Our findings suggest that respect and social inclusion are relevant across all eight domains of the WHO AFC Guide. It is core to an AFC and should be reflected in both city-based policies and evaluations.
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Affiliation(s)
- Sara Ronzi
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool L69 3DT, UK; (L.O.); (N.B.); (D.P.)
- Correspondence:
| | - Lois Orton
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool L69 3DT, UK; (L.O.); (N.B.); (D.P.)
- Department of Sociological Studies, University of Sheffield, Sheffield S10 2TU, UK
| | - Stefanie Buckner
- Cambridge Public Health, University of Cambridge, Cambridge CB2 0SR, UK;
| | - Nigel Bruce
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool L69 3DT, UK; (L.O.); (N.B.); (D.P.)
| | - Daniel Pope
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool L69 3DT, UK; (L.O.); (N.B.); (D.P.)
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Codd H. Prisons, Older People, and Age-Friendly Cities and Communities: Towards an Inclusive Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9200. [PMID: 33317095 PMCID: PMC7764347 DOI: 10.3390/ijerph17249200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Abstract
This original and ground-breaking interdisciplinary article brings together perspectives from gerontology, criminology, penology, and social policy to explore critically the nature and consequences of the lack of visibility of prisons, prisoners, and ex-prisoners within global research, policy and practice on age-friendly cities and communities (AFCC), at a time when increasing numbers of people are ageing in prison settings in many countries. In addition, the COVID-19 pandemic continues to pose challenges in the contexts both of older peoples' lives, wellbeing, and health, and also within prison settings, and thus it is timely to reflect on the links between older people, prisons, and cities, at a time of ongoing change. Just as there is an extensive body of ongoing research exploring age-friendly cities and communities, there is extensive published research on older people's experiences of imprisonment, and a growing body of research on ageing in the prison setting. However, these two research and policy fields have evolved largely independently and separately, leading to a lack of visibility of prisons and prisoners within AFCC research and policy and, similarly, the omission of consideration of the relevance of AFCC research and policy to older prisoners and ex-prisoners. Existing checklists and tools for assessing and measuring the age-friendliness of cities and communities may be of limited relevance in the context of prisons and prisoners. This article identifies the potential for integration and for cross-disciplinary research in this context, concluding with recommendations for developing inclusive research, policies, and evaluation frameworks which recognise and include prisons and older prisoners, both during and after incarceration.
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Affiliation(s)
- Helen Codd
- School of Justice, University of Central Lancashire, Preston PR1 2HE, UK
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Sánchez-González D, Rojo-Pérez F, Rodríguez-Rodríguez V, Fernández-Mayoralas G. Environmental and Psychosocial Interventions in Age-Friendly Communities and Active Ageing: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8305. [PMID: 33182710 PMCID: PMC7696667 DOI: 10.3390/ijerph17228305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 01/04/2023]
Abstract
Background: The academic literature contains little information regarding the interventions that create age-friendly cities and communities in order to promote active ageing. Objectives: A systematic review was carried out to determine the available empirical evidence in relation to the characteristics, content and effectiveness of interventions aimed at improving environmental and psychosocial risk factors for older people, from the perspective of age-friendly communities and the promotion of active ageing. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the studies retained in this review were identified through a systematic search of the academic literature in selected electronic databases including Web of Science and Scopus. Independent critical appraisal and data extraction were conducted by two reviewers. The checklist was used to assess the quality of the articles. Findings: The search identified 1020 potentially eligible documents, of which 11 satisfied the established criteria. Non-exhaustive practices prevailed over rigorous investigations, with a high proportion of studies observed to be of low methodological quality and at high risk of bias. This reflected the predominance of uncontrolled interventions. Environmental interventions were focused on reducing risk and adapting the everyday environmental setting, while psychosocial interventions prioritised social strategies (behavioural changes, promotion of participation) and training. Interventions were more effective in certain domains of age-friendly cities and communities such as transportation and housing, followed by increased participation as a lifestyle-related behavioural change. The inferred changes were associated with providing information and enhancing skills; modifying access, barriers, exposures, and opportunities; enhancing services and support; continuity and effectiveness of changes over time; and modifying policies based on the bottom-up approach of age-friendly cities and communities (AFCC). Discussion and conclusion: Interventions focused on personal and organisational aspects might have positive effects in the longer term. However, fewer changes would be observed in interventions revolving around changing lifestyles owing to the impact of complex multi-causal factors. The relative effectiveness in terms of health calls into question the design of interventions and the supposed "friendliness" of certain communities. There is a need to encourage sound longitudinal research aimed at providing key knowledge for the implementation and evaluation of public policies, and to encourage age-friendly community programmes to promote active ageing.
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Affiliation(s)
- Diego Sánchez-González
- Department of Geography, National Distance Education University (UNED), 28040 Madrid, Spain
| | - Fermina Rojo-Pérez
- Research Group on Ageing (GIE-CSIC), Institute of Economics, Geography and Demography (IEGD), Spanish National Research Council (CSIC), 28037 Madrid, Spain; (F.R.-P.); (V.R.-R.); (G.F.-M.)
- Ageing Network of the Latin American Population Association (ALAP), Rio de Janeiro, Brazil
| | - Vicente Rodríguez-Rodríguez
- Research Group on Ageing (GIE-CSIC), Institute of Economics, Geography and Demography (IEGD), Spanish National Research Council (CSIC), 28037 Madrid, Spain; (F.R.-P.); (V.R.-R.); (G.F.-M.)
- Ageing Network of the Latin American Population Association (ALAP), Rio de Janeiro, Brazil
| | - Gloria Fernández-Mayoralas
- Research Group on Ageing (GIE-CSIC), Institute of Economics, Geography and Demography (IEGD), Spanish National Research Council (CSIC), 28037 Madrid, Spain; (F.R.-P.); (V.R.-R.); (G.F.-M.)
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Reuter A, Liddle J, Scharf T. Digitalising the Age-Friendly City: Insights from Participatory Action Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218281. [PMID: 33182453 PMCID: PMC7665142 DOI: 10.3390/ijerph17218281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022]
Abstract
The World Health Organization’s age-friendly city initiative emerged as a response to the intersecting global trends of population ageing and urbanisation. However, a third global trend—digitalisation—has largely been overlooked in research and policy making relating to age-friendly cities and communities. Within the context of a general shift towards online civic participatory activities, this article explores older adults’ digital citizenship in an age-friendly city in the North of England. Drawing on interviews, observations and field notes from design workshops as part of an ongoing participatory action research project, we consider two key questions. First, how does an age-friendly city stakeholder organisation of older adults make use of digital technologies in order to provide digital information and communications? Second, what is the potential of digital audio to increase civic participation in later life and local engagement with age-friendly issues? Our analysis focuses on two domains of the World Health Organization’s age-friendly city framework: Communication and information and civic participation. First, we report on the stakeholder organisation’s efforts to re-design their digital newsletter in order to provide information and communications to older residents about local work on ageing projects. We then outline the organisation’s efforts, in a public setting, to engage with digital audio as a way to increase the participation of older residents with age-friendly topics. We conclude by suggesting the need to re-frame the role of digital technologies within the age-friendly city, broadening the scope from accessibility towards enhancing digital citizenship opportunities.
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Affiliation(s)
- Arlind Reuter
- Open Lab, Newcastle University, Newcastle upon Tyne NE4 5TG, UK;
- Correspondence:
| | - Jennifer Liddle
- Open Lab, Newcastle University, Newcastle upon Tyne NE4 5TG, UK;
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Thomas Scharf
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
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Dikken J, van den Hoven RF, van Staalduinen WH, Hulsebosch-Janssen LM, van Hoof J. How Older People Experience the Age-Friendliness of Their City: Development of the Age-Friendly Cities and Communities Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186867. [PMID: 32962226 PMCID: PMC7559304 DOI: 10.3390/ijerph17186867] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/16/2022]
Abstract
The World Health Organization engages cities and communities all over the world in becoming age-friendly. There is a need for assessing the age-friendliness of cities and communities by means of a transparently constructed and validated tool which measures the construct as a whole. The aim of this study was to develop a questionnaire measuring age-friendliness, providing full transparency and reproducibility. The development and validation of the Age Friendly Cities and Communities Questionnaire (AFCCQ) followed the criteria of the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN). Four phases were followed: (1) development of the conceptual model, themes and items; (2) initial (qualitative) validation; (3) psychometric validation, and (4) translating the instrument using the forward-backward translation method. This rigorous process of development and validation resulted in a valid, psychometrically sound, comprehensive 23-item questionnaire. This questionnaire can be used to measure older people’s experiences regarding the eight domains of the WHO Age-Friendly Cities model, and an additional financial domain. The AFCCQ allows practitioners and researchers to capture the age-friendliness of a city or community in a numerical fashion, which helps monitor the age-friendliness and the potential impact of policies or social programmes. The AFCCQ was created in Dutch and translated into British-English.
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Affiliation(s)
- Jeroen Dikken
- Chair of Urban Ageing, Faculty of Social Work & Education, The Hague University of Applied Sciences, Johanna Westerdijkplein 75, 2521 EN Den Haag, The Netherlands; (J.D.); (R.F.M.v.d.H.)
- Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, Johanna Westerdijkplein 75, 2521 EN Den Haag, The Netherlands
| | - Rudy F.M. van den Hoven
- Chair of Urban Ageing, Faculty of Social Work & Education, The Hague University of Applied Sciences, Johanna Westerdijkplein 75, 2521 EN Den Haag, The Netherlands; (J.D.); (R.F.M.v.d.H.)
| | | | | | - Joost van Hoof
- Chair of Urban Ageing, Faculty of Social Work & Education, The Hague University of Applied Sciences, Johanna Westerdijkplein 75, 2521 EN Den Haag, The Netherlands; (J.D.); (R.F.M.v.d.H.)
- Institute of Spatial Management, Faculty of Environmental Engineering and Geodesy, Wrocław University of Environmental and Life Sciences, ul. Grunwaldzka 55, 50-357 Wrocław, Poland
- Correspondence: ; Tel.: +31-6-23381404
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Flores R, Caballer A, Alarcón A. Evaluation of an Age-Friendly City and Its Effect on Life Satisfaction: A Two-Stage Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E5073. [PMID: 31842329 PMCID: PMC6950445 DOI: 10.3390/ijerph16245073] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 11/21/2022]
Abstract
Due to the ageing of the world's population, age-friendly cities are emerging to promote active ageing by optimising opportunities for health, participation and safety, in order to improve the quality of life of older people. Despite initiatives in different countries, there is a lack of empirical research exploring their impact on older people. The objective of this study is to evaluate an age-friendly city by analysing its relationship with life satisfaction, taking into account the age cohort variables of the elderly and whether they live alone or with someone else. A two-stage study, in which 66 subjects participated in the qualitative analysis (focus groups) in Stage I and 203 of the quantitative analysis (survey methodology) or Stage II. Despite the differences found in the different groups of elderly persons, for all of them the domains of outdoor spaces and buildings, and community support and health services, are significantly related to life satisfaction, with the latter showing itself to be a predictor of such satisfaction. It is important to take into account the different groups of elderly persons, so as to be able to establish suitable specific actions. This study aims to make a contribution to the development of public policies that influence the life satisfaction of the elderly.
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Affiliation(s)
- Raquel Flores
- Department of Developmental, Educational and Social Psychology and Methodology. Universitat Jaume I, Castellón 12071, Spain; (A.C.); (A.A.)
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Ronzi S, Orton L, Pope D, Valtorta NK, Bruce NG. What is the impact on health and wellbeing of interventions that foster respect and social inclusion in community-residing older adults? A systematic review of quantitative and qualitative studies. Syst Rev 2018; 7:26. [PMID: 29382375 PMCID: PMC5789687 DOI: 10.1186/s13643-018-0680-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 01/12/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many interventions have been developed to promote respect and social inclusion among older people, but the evidence on their impacts on health has not been synthesised. This systematic review aims to appraise the state of the evidence across the quantitative and qualitative literature. METHODS Eligible studies published between 1990 and 2015 were identified by scanning seven bibliographic databases using a pre-piloted strategy, searching grey literature and contacting experts. Studies were included if they assessed the impact (quantitatively) and/or perceived impact (qualitatively) of an intervention promoting respect and social inclusion on the physical or mental health of community-residing people aged 60 years and older. Titles and abstracts were screened for eligibility by one reviewer. A second reviewer independently screened a 10% random sample. Full texts were screened for eligibility by one reviewer, with verification by another reviewer. Risk of bias was assessed using standardised tools. Findings were summarised using narrative synthesis, harvest plots and logic models to depict the potential pathways to health outcomes. RESULTS Of the 27,354 records retrieved, 40 studies (23 quantitative, 6 qualitative, 11 mixed methods) were included. All studies were conducted in high and upper middle-income countries. Interventions involved mentoring, intergenerational and multi-activity programmes, dancing, music and singing, art and culture and information-communication technology. Most studies (n = 24) were at high or moderate risk of bias. Music and singing, intergenerational interventions, art and culture and multi-activity interventions were associated with an overall positive impact on health outcomes. This included depression (n = 3), wellbeing (n = 3), subjective health (n = 2), quality of life (n = 2), perceived stress and mental health (n = 2) and physical health (n = 2). Qualitative studies offered explanations for mediating factors (e.g. improved self-esteem) that may lead to improved health outcomes and contributed to the assessment of causation. CONCLUSIONS Whilst this review suggests that some interventions may positively impact on the health outcomes of older people, and identified mediating factors to health outcomes, the evidence is based on studies with heterogeneous methodologies. Many of the interventions were delivered as projects to selected groups, raising important questions about the feasibility of wider implementation and the potential for population-wide benefits. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42014010107.
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Affiliation(s)
- S. Ronzi
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - L. Orton
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - D. Pope
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - N. K. Valtorta
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - N. G. Bruce
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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