Environmental influences on healthy and active ageing: a systematic review

Nurturing the Seeds of Participation: Unveiling the Foundational Path for Understanding Aging in Place Barriers and Facilitators From the Perspective of Older Adults Using Mixed Methods and Translational Science

Participation in society is a cornerstone for quality of life, active aging, and aging in place. While the majority of older adults prefer aging in place, health and financial challenges can hinder this vision. Conducted in suburban South Jersey, this study utilized mixed methods, including surveys and interviews with older adult participants. Surveys indicated that satisfaction with participation in the community is influenced by functional ability, healthcare service availability, and information access. Interviewees identified suggestions to overcome barriers (e.g., improve access to community and address ageism). Combined results provide a theory of change which suggests older adults' empowerment in community participation hinges on home living support, participation options aligning with ability and interest, and accessible information on community events. This person-centered planning approach emphasizes the importance of older adult and stakeholder participation in foundational community planning, offering translational foundational tools for evidence-based strategies to engage them in future community action plans (CAPs).

Understanding the important characteristics of neighbourhoods to facilitate ageing in place and longevity

OBJECTIVES

This study investigates which local area characteristics, included in the Healthy Ageing/Vulnerable ENvironment (HAVEN) Index, are the strongest factors predicting transition into permanent residential aged care (PRAC) and mortality, and the geographic distribution of these factors.

METHODS

A retrospective cohort study of older individuals living in the community in Adelaide who received their first eligibility assessment for age care services between 2013 and 2015 (n = 16,939) was conducted. The study cohort, from the Registry of Senior Australians (ROSA), was linked by postcode to HAVEN Index items, selected following item response theory (IRT) analysis to determine the strongest local area factors associated with PRAC and mortality. Geospatial mapping of the factors determined the geographic distribution of these significant factors.

RESULTS

Fourteen HAVEN Index items were associated with entry into PRAC and mortality. Three area-level items, lower educational attainment, financial housing stress and low levels of volunteering by older people, were risk factors for entry into PRAC and mortality while the remainder of the items identified were different for each outcome. The mapped local area risk factors for each outcome highlighted similar geographical areas of vulnerability.

CONCLUSIONS

Local area characteristics are associated with entering PRAC and mortality. Our findings can inform area-level responses to make neighbourhoods more age-friendly, potentially allowing more people to age longer in place. Similar analyses, conducted for other areas, could provide evidence to support the widespread development of age-friendly neighbourhoods reducing area-level inequalities in ageing.

The Role of the Built Environment in Supporting Older Adults' Engagement: A Narrative Literature Review

OBJECTIVE

This literature review aimed to summarize the existing knowledge surrounding the role of the built environment in supporting older adults' physical and social engagement and identify opportunities for future research and design that facilitates older adults' engagement at multiple environmental scales: from interior spaces to neighborhoods.

BACKGROUND

Physical environments can support or impede older adults' physical and social engagement: willful, motivated involvement in meaningful activity or occupation. Research shows that engagement is a core component of health and well-being and relates to positive health outcomes, including reduced disease risk, better mental health, and improved physical and cognitive function. Thus, designing supportive built environments for engagement can yield significant, positive health and well-being impacts.

METHODS

A systematized search of five databases, a hand search, and an iterative screening process identified 55 studies for inclusion in this review. Through inductive thematic analysis, this review summarizes findings regarding the built environment's role in physical and social engagement in older age and design strategies to facilitate engagement and support health and well-being.

RESULTS

Evidence indicates that built environment characteristics can influence older people's physical and social engagement in homes, neighborhoods, and care settings. The thematic analysis of the included studies identified three key themes concerning the relationships of built environment characteristics to older adults' engagement across multiple environmental scales: connection, access, and security.

CONCLUSIONS

Built environments influence older people's physical and social engagement, significantly affecting their health, well-being, abilities, and longevity. Numerous design strategies can support older adults' engagement, but more research is needed.

"We never lived together either": Couples' housing (re-) arrangements in later life

Social gerontology mainly addresses couples' housing arrangements in later life by focusing on partner's care, related adaptations in place, and changing role expectations within the couple relationship. Thereby, the resulting image does not fully represent today's diversity of couples' housing arrangements. This article considers housing arrangement and relationship orientation of older couples as entangled in social practice, providing a broader perspective on the diversity and dynamics of couples living arrangements in later life. In a qualitative study, we conducted joint in-depth interviews with ten couples from Germany aged 58 to 88 years. Couples talked about their shared biography and living together today. Data were merged with fieldnotes on housing constellations and analyzed following the documentary method. Couples co-constitute living together by using space in different ways. We found three relationship orientations of couples corresponding to practices of couples' housing arrangements: balancing physical and emotional presence by negotiating shared space, exploring presence by having a third common place, and reducing presence by separate housing. These orientation types which are linked with spatial (re-) arrangements reveal positioning to housing preferences in past relationships and point to societal concepts of coupledom as regards housing in later life. Space gives options for both being apart from and feeling close to the partner, partially at the same time. Diversity and dynamics of housing arrangements correspond to diversified and altering relationship orientations in later life. Considering couples' housing arrangements in later life as mutually constitutive broadens the options to examine the meaning of space in aging together. Moreover, this perspective can be combined with a critical approach towards stereotypical (hetero-) normative biases in research.

Individual and environmental factors associated with successful aging among Korean older adults: Multilevel analysis of cross-sectional nationwide survey data

PURPOSE

The importance of environmental influences on successful aging has recently been emphasized. However, existing studies that investigated environmental factors related to successful aging in older adults did not apply multi-level analysis while simultaneously examining individual and environmental factors related to successful aging. Therefore, this study aimed to determine the level of successful aging in older adults and the individual and environmental factors related to successful aging.

MATERIALS AND METHODS

Data from a nationwide survey were used. The study comprised a cross-sectional sample of 73,942 community-dwelling adults aged ≥65 years with individual-level data drawn from the 2019 Korea Community Health Survey. Community-level data of 255 local administrative districts (cities or counties) were extracted from the Community Health Determinant Database from 2017 to 2019. These data were merged and used in multi-level logistic regression analyses.

RESULTS

Generally, 27.1% of the participants achieved successful aging. Individual factors including sex, age, marital status, education level, job, monthly household income, smoking, physical activity, and body mass index were significantly associated with successful aging. Four environmental factors, urban residential area, social network, satisfaction with living environment, and air quality, were positively associated with successful aging at the community level; among them, high satisfaction with living environment (OR = 6.06, 95% CI: 2.43-15.12) was the most strongly associated factor with successful aging.

CONCLUSIONS

The findings suggest that environmental factors are essential for successful aging among older adults in addition to individual factors. Therefore, multiple strategies considering individual and environmental factors are needed to improve successful aging.

Employing citizen science to enhance active and healthy ageing in urban environments

Engaging older residents in problem definition and solution-building is key to the success of place-based initiatives endeavouring to increase the age-friendliness of urban environments. This study employed the Our Voice framework, engaging older adult citizen scientists (n = 14) and community stakeholders (n = 15) across the city of Birmingham, UK. With the aim of identifying urban features impacting age friendliness and co-producing recommendations for improving local urban areas, citizen scientists participated in 12 technology-enabled walkability assessments, three in-person discussion groups, two one-to-one online discussions, and two workshops with community stakeholders. Together, citizen scientists co-produced 12 local and six city-wide recommendations. These recommendations were embedded into an implementation framework based on workshop discussions to identify age-friendly pathways in urban environments.

The influencing factors of elder-friendly public open spaces promoting older adults' health in deprived urban neighborhoods: Partial Least Square Structural Equation Modeling approach

Background

Public open spaces (POSs) is considered a feature of the built environment that is important for physical, mental, and social health during life and contributes to active aging. Hence, policymakers, practitioners, and academics have recently focused on indicators of elder-friendly environments, particularly in developing countries.

Objective

This study aimed to examine the attributes of POSs and socio-demographic status that positively influence older people's health in Tehran's deprived neighborhoods using a pathway model.

Methods

We employed a pathway model to explore the relationships between place function, place preferences, and process in the environment as the perceived (subjective) positive features of POSs associated with older adults' health, compared to the objective attributes of POSs. We also included personal characteristics, including physical, mental, and social dimensions, to explore how these factors are related to the health of older adults. To assess the subjective perception of POSs attributes, 420 older adults were asked to complete Elder-Friendly Urban Spaces Questionnaire (EFUSQ) from April 2018 to September 2018 in the 10th District of Tehran. We used the SF-12 questionnaire and "The self-Rated Social Health of Iranians Questionnaire to measure older people's physical and mental health and elder social health." Geographical Information System (GIS) measures (Street connectivity, Residential density, Land use mix, Housing quality) were derived as objective measures of neighborhood features.

Results

According to our findings, the personal aspect, socio-demographic status (such as Gender, Marital status, Education, Occupation as well as Frequency of being present in POSs), place preferences (Security, Fear of Falling, Way Finding and Perceived Aesthetics), and process in the environment's latent (Social Environment, Cultural Environment, Place Attachment, and Life Satisfaction)constructs collectively influenced the elders' health.

Conclusion

We found positive associations between Place preference, Process-in-environment, and personal health-related factors to elders' health (social, mental, and physical). The path model presented in the study could be guided in future research in this area and inform the development of evidence-based urban planning and design interventions for improve older adults health and social functioning and quality of life.

Older Adults Living in Disadvantaged Areas: Protocol for a Mixed Methods Baseline Study on Homes, Quality of Life, and Participation in Transitioning Neighborhoods

BACKGROUND

Swedish policy states that older adults should be able to age safely with continued independence and lead active lives. However, this plays out differently in different Swedish municipalities depending upon degree of demographic change, globalization, and urbanization. Internationally, older adults living in disadvantaged areas have worse physical and mental health, activity restrictions, and reduced life expectancy. In Sweden, research on how disadvantaged areas impact older adults' quality of life is virtually nonexistent. We argue that disadvantaged areas exist in both urban and rural contexts.

OBJECTIVE

We aimed to investigate how older adults' homes and neighborhoods influence their community participation, quality of life, identity, and belonging in urban and rural disadvantaged areas in Sweden, and how these person-context dynamics are experienced by older adults in transitioning neighborhoods.

METHODS

The study has a mixed methods design and includes 3 phases. Adults 65 years and older living in certain urban and rural disadvantaged areas in the south of Sweden will be included. Phase 1 is an interview study in which qualitative data are collected on neighborhood attachment, identity, and belonging through semistructured interviews and photo-elicitation interviews with 40 subjects. A variety of qualitative data analysis procedures are used. In phase 2, a survey study will be conducted to explore associations between observable and self-rated aspects of housing and neighborhood (physical, social, and emotional), participation, and quality of life; 400 subjects will be recruited and added to the 40 phase-1 subjects for a total of 440. The survey will include standardized measures and study-specific questions. Survey data will be analyzed with mainstream statistical analyses and structural equation modeling to understand the interactions between quality of life, home and neighborhood factors, and sociodemographic factors. In phase 3, the integration study, survey data from the 40 participants who participated in both data collections will be analyzed together with qualitative data with a mixed methods analysis approach.

RESULTS

As of the submission of this protocol (August 2022), recruitment for the interview study is complete (N=39), and 267 participants have been recruited and have completed data collection in the survey study. We expect recruitment and data collection to be finalized by December 2022.

CONCLUSIONS

With an increasing proportion of older adults, an increasing number of disadvantaged areas, and an increasing dependency ratio in more than 50% of Swedish municipalities, these municipalities are transforming and becoming increasingly segregated. This study will add unique knowledge on what it is like to be older in a disadvantaged area and deepen knowledge on housing and health dynamics in later life. Further, the design of the current study will allow future follow-up studies to facilitate longitudinal analysis (if funding is granted) on aging in a transforming societal context.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41255.

Engaging community-dwelling older adults as co-developers in a public outdoor exercise facilities-based physical activity education intervention: A mixed-method participatory study in Hong Kong

In Hong Kong, an increasing number of outdoor exercise facilities have been established in public open spaces to promote physical activity (PA) in older adults. However, no intervention is dedicated in educating the public on how to make use of these resources to fulfil the PA guidelines based on behavioural change theory. This study has two phases, phase one aims to describe the participatory development of the intervention, and phase two is the evaluation of a public outdoor exercise facilities-based PA education intervention for community-dwelling older adults. A mixed-methods participatory design was used to evaluate the impact of the intervention. PA behaviour was assessed as the fulfilment of the PA recommendations by World Health Organization, and the Rapid Assessment of Physical Activity (RAPA) scale at baseline, immediately, and 3 and 6 months post-intervention. Psychosocial constructs and physical assessments were carried out at both pre- and post-intervention. Individual in-depth interviews were conducted at post-intervention. Forty-seven participants were enrolled in the intervention. The average adherence rate was 90.87%. PA significantly increased after the intervention and remained elevated for the following 6 months. Post-intervention, the qualitative findings supported the quantitative findings at both the individual and social levels. However, findings regarding the change in participants' usage of environmental resources were divergent. The intervention was well-received by the participating older adults, as reflected by the high adherence rate. Both quantitative and qualitative data demonstrated the overall impacts of the intervention for creating sustainable changes in PA behaviour.

Urban-rural variation in the association between social support availability and cognitive function in middle-aged and older adults: Results from the baseline Tracking Cohort of the Canadian Longitudinal Study on Aging

The purpose of this study was to investigate if and how the associations between social support availability (SSA) and cognitive function varied across urban, rural, and geographical regions in Canada. Data from a population-level sample of community-dwelling adults aged 45-85 years were obtained from the baseline Tracking Cohort of the Canadian Longitudinal Study on Aging. The associations between SSA and two domains of cognitive function, memory and executive function, were analyzed using multilevel regression models. SSA was positively and significantly associated with both executive function and memory. We found SSA had stronger positive associations with executive function among participants living in rural areas compared to urban areas in all geographical regions; however, geographical variation in the associations between SSA and memory were not supported by model results. Understanding how the associations between cognitive function and modifiable risk factors, including SSA, vary across geographical contexts is important for developing policies and programs to support healthy aging.

Sedentary Behavior and Physical Inactivity in the Asia-Pacific Region: Current Challenges and Emerging Concerns

This editorial sets the scene for our Special Issue on the growing problem of sedentary behavior and physical inactivity in the Asia-Pacific region. In many societies, more than 40% of the adult population and growing numbers of children are insufficiently physically active to safeguard their health. This is contributing to high rates of cardiovascular disease, obesity, and other deleterious health outcomes across the region. The Asia-Pacific is heterogeneous and complex, with diverse social, cultural, and environmental barriers that affect intentions and opportunities for regular physical activity. Recently, the problem has been compounded by the acceleration of population aging, the worsening effects of anthropogenic climate change, and the ongoing COVID-19 pandemic. Without strong leadership, enduring funding support, and innovative interventions that cut across policy and society, we may yet be facing a century of unmitigated expansion of morbidity across the Asia-Pacific.

Active Ageing Awareness and Quality of Life among Pre-Elder Malaysian Public Employees

Increasing life expectancy has led to a global rise in late-life diseases. Quality of Life (QOL) is important for healthy life expectancy. The active ageing framework serves as a guide for policymakers to design policies that enhance the QOL of older people. This study aims to determine the association between awareness of active ageing and QOL. The Malay version of the 26-item WHOQOL-BREF questionnaire was utilised along with the 14-item Active Ageing Awareness Questionnaire (AAAQ). A total of 532 participants had a mean (SD) age of 50.2 (5.9), were largely ethnic Malay (96.2%), female (52.8%), and comprised largely of low-income households (65.4%). The median (IQR) AAAQ score was 71.4 (19.1). The hierarchical multiple regression analysis revealed significant positive association between AAAQ and the QOL domains of physical (β = 0.154, p < 0.001), psychological (β = 0.196, p < 0.001), social relationship (β = 0.175, p < 0.001), and environment (β = 0.145, p < 0.001) after adjusting for all covariates. Awareness of active ageing was found to have a positive effect on all domains of QOL among pre-elder employees, and thus, we recommend that policies to improve active ageing awareness should be implemented for healthy life expectancy in ageing populations.

Indoor Built Environment and Older Adults' Activity: A Systematic Review

Although the physical environment can influence people's activity, there are few knowledge syntheses for indoor environments and older adults' daily life routines. Therefore, we conducted a systematic review of peer-reviewed evidence to inform future research and practice. Inclusion criteria were studies with any research designs, across all years and languages focused on older adults 60 years of age or more, on physical activity/sedentary behaviour and the indoor environment. After searching five databases, two authors completed title/abstract and full-text screening. The last search was on December 19, 2020. We screened 1,367 citations, and included 23 studies situated in private or collective dwellings (e.g., assisted living). We identified physical activity-supportive indoor features across three domains: campus (e.g., amenities, pathways), building (e.g., area, floor level), and fixtures (e.g., elevators, hallways). Knowledge of indoor environmental factors for older adults' engagement in daily activities can guide future research and policy on housing design.

The longitudinal associations between proximity to local grocery shops and functional ability in the very old living with and without multimorbidity: Results from the Newcastle 85+ study

BACKGROUNDS

The very old, people aged ≥85, is a fast-growing age group with high risk of disability and dependence. To identify environmental factors that support maintenance of functional ability, the aim of this study is to investigate the longitudinal associations between proximity to local grocery shops and the ability to shop for groceries in the very old and to examine the potential variation between those living with and without multimorbidity.

METHODS

This study was based on the Newcastle 85+ study, a population-based cohort of people aged 85 in North-East England. The numbers of grocery shops were identified within a 500 m road distance to participants' residence. Multilevel Poisson regression modelling was used to investigate whether proximity to local grocery shops was associated with the ability to do grocery shopping over five years in those with and without multimorbidity adjusting for sociodemographic factors and area deprivation.

RESULTS

The very old who lived in more deprived areas were more likely to have a grocery shop within 500 m than those in less deprived areas. Proximity to local grocery shops was not associated with the ability to do grocery shopping in the participants who had none or one chronic condition (IRR: 1.00; 95% CI: 0.89, 1.12) but moderated loss of the ability in those living with multimorbidity (IRR: 0.82; 95% CI: 0.70, 0.96).

CONCLUSIONS

For the very old living with multimorbidity, proximity to local grocery shops may support their functional ability. Future research should investigate how to support older people with poor health to access local grocery shops.

Ageing in place processes in the neighbourhood environment: a proposed conceptual framework from a capability approach

The concept of "ageing in place" has become increasingly significant in the environmental gerontology literature. Despite its predominance, there have been limited efforts to offer a more comprehensive and nuanced conceptualization of this topic. Definitions found in the literature are often too simplistic and only partially capture the various aspects of older adults' experience while ageing in place. This paper presents a conceptual framework on ageing in place in the context of neighbourhood environment which aims to address this gap by proposing a multi-faceted understanding of ageing in place processes through the lenses of a capability approach, a more comprehensive definition of the concept, and related overarching principles. Building on predominant theories in environmental gerontology, this conceptual framework offers new insights into the interactions between "place" and the "ageing individual". It is meant to offer opportunities for discussion, to suggest new paths of inquiry, and to explore implications for policy and practice.

A vulnerable residential environment is associated with higher risk of mortality and early transition to permanent residential aged care for community dwelling older South Australians

OBJECTIVES

This study examined the impact of the residential environment, measured by the Healthy Ageing/Vulnerable ENvironment (HAVEN) Index, on risk of mortality or entry into Permanent Residential Aged Care (PRAC).

DESIGN

A retrospective cohort study using data from the Registry of Senior Australians (ROSA) was conducted. HAVEN Index values were matched to the ROSA by residential postcode.

STUDY SETTING AND PARTICIPANTS

Older individuals living in metropolitan Adelaide and receiving their first eligibility assessment for aged care services between 2014 and 2016 (N = 16,944).

MAIN OUTCOME MEASURE

Time to death and entry into PRAC were the main outcomes.

RESULTS

A higher HAVEN Index value, which represents a favourable residential environment, was associated with a lower risk of mortality and delayed entry to PRAC. For every 0.1 unit increase in HAVEN Index value, the risk of mortality is 3% lower (adjusted hazard ratio [HR], 95% confidence interval [CI] = 0.97, 0.96-0.99) and the risk of entry to PRAC is 5% lower (adjusted subdistribution HR, 95%CI = 0.95, 0.94-0.97) in the first 2 years following aged care assessment. After 2 years, the HAVEN Index was not associated with the risk of transition to PRAC.

CONCLUSION

Place-based health inequalities were identified in Australians seeking aged care services, demonstrating that a better understanding of local neighbourhoods may provide insight into addressing ageing inequalities. Spatial indexes, such as the HAVEN Index, are useful tools to identify areas where populations are more vulnerable to adverse health outcomes, informing responses to prioritise local improvements and health interventions to enable healthy ageing.

Do Remittances Enhance Elderly Adults' Healthy Social and Physical Functioning? A Cross-Sectional Study in Nigeria

Existing research demonstrates that the effect of remittances on different health outcomes of elderly adults in low-income countries with inadequate social security is inconclusive. The present study set out to fill this gap by examining the effects of receiving remittances on the healthy social and physical functioning of Nigeria’s elderly adults. We also investigate the nonlinear association between remittances and social and physical functioning to identify the minimum amount required to engender healthy social and physical functioning in Nigerian elderly adults. This study utilized data from the 2018/2019 Nigerian Living Standard Survey (NLSS), which included 55,350 young people aged 12–44 (control group) and 18,937 elderly adults aged 45 and above (treatment group). We addressed our objectives using logistic regression-adjusted predicted probabilities and predictive margins. The results reveal that remittance recipients have higher healthy social functioning probabilities than non-recipients. We also found that the influence that remittances have on social functioning depends on the amount of the remittances received. Quantitatively, receiving more than NGN 1,200,000 in remittances ensures increased social functioning probabilities. Given the disparity between the average remittance amount of NGN 54,306.92 received by elderly adults and the NGN 1,200,000 threshold associated with healthy social functioning, bridging this gap is paramount for promoting social functioning among Nigerian elderly adults. We also discussed policy implications for fostering the healthy aging of the population in the interim.

Differences in the Correlation between the Built Environment and Walking, Moderate, and Vigorous Physical Activity among the Elderly in Low- and High-Income Areas

Studies have proved that activity and fitness behaviors are closely related to the quality of life and health status of the elderly. However, different intensities of physical activity (PA)—walking, moderate PA, and vigorous PA—have different correlations with the built environment (BE). This study combines the high and low socioeconomic status (SES) of Guangzhou to establish two types of BE models. The physical activity time of 600 elderly people was collected from questionnaires. Through ArcGIS software, 300 m, 500 m, 800 m, and 1000 m buffer zones were identified, and the land use diversity, street design, population density, distance to destination, distance to public transportation—the five Ds of the BE—were measured. SPSS software was adopted to analyze the correlation between the BE and PA. Results: The PA of people living in low-SES areas was more dependent on the BE, whereas the correlation may be limited in high SES areas. Moreover, in low SES areas, walking was negatively correlated with street connectivity; moderate PA was positively correlated with street connectivity and the shortest distance to the subway station, but negatively correlated with the density of entertainment points of interest (POIs). Studying the relevant factors of the environment can propose better strategies to improve the initiative of the elderly to engage in PA.

Strategic Assessment of Neighbourhood Environmental Impacts on Mental Health in the Lisbon Region (Portugal): A Strategic Focus and Assessment Framework at the Local Level

Scientific evidence shows that each place/environment generates specific conditions with associated impacts on the mental health and well-being of the population. A holistic, multilevel and integrated environmental approach to mental health enhances the understanding of this phenomena, supporting the local decision-making processes to improve spatial planning of neighbourhood environments. The aim of this study is to develop a strategic assessment framework, based on four municipalities in the Lisbon Region (Portugal), that explores policy and planning initiatives capable of generating favourable neighbourhood environmental conditions for mental health while also detecting risks. Using baseline results of significant statistical associations between individuals’ perceptions of their neighbourhood environment and their mental health in the Lisbon Region, a Strategic Focus on Environmental and Mental Health Assessment framework (SEmHA) was built, by applying the methodology “Strategic Thinking for Sustainability” in Strategic Environmental Assessment, developed by Partidário in 2012. Taking into account the promotion of the population’s mental health, four critical decision factors of neighbourhood environments were identified: (1) public space quality (e.g., improving sense of place), (2) physical environment quality (e.g., low levels of noise exposure), (3) professional qualification and creation of economic activities (e.g., attracting new economic activities), and (4) services and facilities (e.g., improving access to health and education services). The proposed strategic focus and assessment framework contributes to ensuring that interventions in neighbourhood environments truly achieve community mental health benefits and reduce inequalities, thus helping policy makers to assess impacts at the local level.

Mitigating feelings of loneliness and depression by means of web-based or print-based physical activity interventions: Pooled analysis of two community-based intervention trials (Preprint)

Background

Physical activity (PA) is associated with benefits, such as fewer depressive symptoms and loneliness. Web- and print-based PA interventions can help older individuals accordingly.

Objective

We aimed to test the following research questions: Do PA interventions delivered in a web- or print-based mode improve self-reported PA stage of change, social-cognitive determinants of PA, loneliness, and symptoms of depression? Is subjective age a mediator and stage of change a moderator of this effect?

Methods

Overall, 831 adults aged ≥60 years were recruited and either allocated to a print-based or web-based intervention group or assigned to a wait-list control group (WLCG) in 2 community-based PA intervention trials over 10 weeks. Missing value imputation using an expectation-maximization algorithm was applied. Frequency analyses, multivariate analyses of variance, and moderated mediation analyses were conducted.

Results

The web-based intervention outperformed (47/59, 80% of initially inactive individuals being adopters, and 396/411, 96.4% of initially active individuals being maintainers of the recommended PA behavior) the print-based intervention (20/25, 80% of adopters, and 63/69, 91% of maintainers) and the WLCG (5/7, 71% of adopters; 141/150, 94% of maintainers). The pattern regarding adopters was statistically significant (web vs print Z=–1.94; P=.02; WLCG vs web Z=3.8367; P=.01). The pattern was replicated with stages (χ²₄=79.1; P<.001; contingency coefficient 0.314; P<.001); in the WLCG, 40.1% (63/157) of the study participants moved to or remained in action stage. This number was higher in the groups receiving web-based (357/470, 76%) or print-based interventions (64/94, 68.1%). A significant difference was observed favoring the 2 intervention groups over and above the WLCG (F_{19, 701}=4.778; P<.001; η²=0.098) and a significant interaction of time and group (F_{19, 701}=2.778; P<.001; η²=0.070) for predictors of behavior. The effects of the interventions on subjective age, loneliness, and depression revealed that both between-group effects (F_{3, 717}=8.668; P<.001; η²=0.018) and the interaction between group and time were significant (F_{3, 717}=6.101; P<.001; η²=0.025). In a moderated mediation model, both interventions had a significant direct effect on depression in comparison with the WLCG (web-based: c′ path −0.86, 95% CI −1.58 to −0.13, SE 0.38; print-based: c′ path −1.96, 95% CI −2.99 to −0.92, SE 0.53). Furthermore, subjective age was positively related to depression (b path 0.14, 95% CI 0.05-0.23; SE 0.05). An indirect effect of the intervention on depression via subjective age was only present for participants who were in actor stage and received the web-based intervention (ab path −0.14, 95% CI −0.34 to −0.01; SE 0.09).

Conclusions

Web-based interventions appear to be as effective as print-based interventions. Both modes might help older individuals remain or become active and experience fewer depression symptoms, especially if they feel younger.

Trial Registration

German Registry of Clinical Trials DRKS00010052 (PROMOTE 1); https://tinyurl.com/nnzarpsu and DRKS00016073 (PROMOTE 2); https://tinyurl.com/4fhcvkwy

International Registered Report Identifier (IRRID)

RR2-10.2196/15168

The Moderation of Perceived Comfort and Relations with Patients in the Relationship between Secure Workplace Attachment and Organizational Citizenship Behaviors in Elderly Facilities Staff

This study focuses on caregivers who work in residential facilities (RFs) for the elderly, and specifically on their organizational citizenship behaviors (OCBs) in relation to their interaction respectively with the overall context (workplace attachment dimension), the spatial-physical environment (perceived environmental comfort), and the social environment (relationship with patients). A sample of health care workers (medical or health care specialists, nurses, and office employees, n = 129) compiled a self-report paper-pencil questionnaire, which included scales measuring the study variables. The research hypotheses included secure workplace attachment style as independent variable, OCBs as the dependent variable, and perceived comfort and relations with patients as moderators. Results showed that both secure workplace attachment and perceived comfort promote OCBs, but the latter counts especially as a compensation of an insecure workplace attachment. As expected, difficult relationships with patients hinder the relationship between secure workplace attachment style and OCBs. In sum, our study highlights the importance of the joint consideration of the psychological, social, and environmental dimensions for fostering positive behaviors in caregivers employed in elderly care settings.

Developing indicators of age-friendly neighbourhood environments for urban and rural communities across 20 low-, middle-, and high-income countries

Background

By 2050, the global population of adults 60 + will reach 2.1 billion, surging fastest in low- and middle-income countries (LMIC). In response, the World Health Organization (WHO) has developed indicators of age-friendly urban environments, but these criteria have been challenging to apply in rural areas and LMIC. This study fills this gap by adapting the WHO indicators to such settings and assessing variation in their availability by community-level urbanness and country-level income.

Methods

We used data from the Prospective Urban and Rural Epidemiology (PURE) study’s environmental-assessment tools, which integrated systematic social observation and ecometrics to reliably capture community-level environmental features associated with cardiovascular-disease risk factors. The results of a scoping review guided selection of 18 individual indicators across six distinct domains, with data available for 496 communities in 20 countries, including 382 communities (77%) in LMIC. Finally, we used both factor analysis of mixed data (FAMD) and multitrait-multimethod (MTMM) approaches to describe relationships between indicators and domains, as well as detailing the extent to which these relationships held true within groups defined by urbanness and income.

Results

Together, the results of the FAMD and MTMM approaches indicated substantial variation in the relationship of individual indicators to each other and to broader domains, arguing against the development of an overall score and extending prior evidence demonstrating the need to adapt the WHO framework to the local context. Communities in high-income countries generally ranked higher across the set of indicators, but regular connections to neighbouring towns via bus (95%) and train access (76%) were most common in low-income countries. The greatest amount of variation by urbanness was seen in the number of streetscape-greenery elements (33 such elements in rural areas vs. 55 in urban), presence of traffic lights (18% vs. 67%), and home-internet availability (25% vs. 54%).

Conclusions

This study indicates the extent to which environmental supports for healthy ageing may be less readily available to older adults residing in rural areas and LMIC and augments calls to tailor WHO’s existing indicators to a broader range of communities in order to achieve a critical aspect of distributional equity in an ageing world.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12438-5.

Delineating the geographic context of physical activities: A systematic search and scoping review of the methodological approaches used in social ecological research over two decades

BACKGROUND

The social ecological approach suggests that the spatial context among other factors influence physical activity behavior. Ample research documents physical environmental effects on physical activity. Yet, to date inconsistent associations remain, which might be explained by conceptual and methodological challenges in measuring the spatial dimensions of health behavior. We review methods applied to measure the spatial contexts in the social ecological physical activity literature.

METHODS

Online databases and selected reviews were used to identify papers published between 1990 and 2020. A total of 2167 records were retrieved, from which 412 studies that used physical activity as a primary outcome variable, included measures of the physical environment and applied the main principles of the social ecological approach, were included.

RESULTS

Subjective approaches were the dominant method to capture the spatial context of physical activities. These approaches were applied in 67% (n=279) of the studies. From the objective approaches an administrative unit was most prevalent and was applied in 29% (n=118) of the studies. The most comprehensive objective spatial methods that capture the true environmental exposure, were used only in 2% (n=10) of the studies.

CONCLUSIONS

Current social ecological physical activity research applies simple conceptualizations and methods of the spatial context. While conceptual and methodological concerns have been repeatedly expressed, no substantive progress has been made in the use of spatial approaches. To further our understanding on place effects on health, future studies should carefully consider the choice of spatial approaches, and their effect on study results.

Place of Residence and Cognitive Function in Older Adults in China: The Mediating Role of Social Participation

Background: Cognitive impairment is a severe health problem faced by older adults and their families, as well as the countries in which they live. Differences in place of residence may contribute to differences in the cognitive function of older adults, and the mediating effect of social participation has rarely been studied in China. Methods: A total of 10,014 older adult participants were included, using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Place of residence was described as either a city, town, or rural area. The frequency of participation in organized social activities and visits and interactions with friends was used to assess both formal and informal social participation. The Chinese version of a Mini-Mental State Examination (MMSE) was used as a measure of cognitive function. The mediation analysis was conducted using Hayes' process version 3.4 on SPSS (IBM, Armonk, NY, USA). Results: Place of residence had a negative effect on cognitive function in older adults. The mediating functions of both informal (a1b1 = 0.199) and formal (a2b2 = -0.056) social participation indicate a suppression effect on the part of informal social participation and a partial mediation effect on the part of formal social participation in terms of the association between place of residence and cognitive function in older adults. Promoting both informal and formal social participation seems to be an important strategy for preventing a decline in the cognitive function of older adults, especially for those living in rural areas.

Moving around a Large City in Latin America: The Mobility Challenges Faced by Older Adults with Disabilities

A growing body of research has shown that barriers in the urban environment can be disabling by reducing the ability of older people to manage independently in the community, but also because they can negatively affect health by limiting the possibilities to move outside the home. In this study, we ask how obstacles in the urban environment are associated with the need for help to go to places in the community. To respond to this question, we used the Annual Household Survey of the City of Buenos Aires, Argentina 2018, which had a specific questionnaire for people with disabilities. From this sample, we selected adults aged 65 years or older with difficulties in at least one of six domains: vision; hearing; upper and lower body mobility; cognition; self-care; and communication. The final sample consisted of 513 persons (weighted = 109,316). First, we conducted a principal component analysis identifying three factors from variables of obstacles to access and use the urban environment: transportation; outdoor spaces; and information. Second, through a logistic regression model, we observed a direct relationship between these factors and the need for help to move in the community, controlling for sociodemographic characteristics, health status, and number of disabilities. This paper provides evidence on the significance of improving urban spaces to reduce dependent mobility. In Latin America, cities still face many challenges in becoming more age-friendly.

Investigating the Association between Outdoor Environment and Outdoor Activities for Seniors Living in Old Residential Communities

Many seniors live in old residential communities (ORCs) with low-quality outdoor environment (OE), which hinders the residents’ outdoor daily activities (ODAs). This paper empirically investigates the association of OE on ODAs for seniors living in ORCs. A questionnaire was designed and distributed in six central districts of Nanjing city. A total of 258 questionnaires was finally collected, of which 60.08%, 29.46%, 9.69%, and 0.78% respondents were scattered into four age groups (61–69, 70–79, 80–89, and ≥90), respectively. Based on reliability analysis, correlation analysis, and regression analysis, the results show that: (1) social activities are mainly associated with noise; (2) leisure activities are significantly associated with road accessibility, slip-resistance measures, greenery, and staff; (3) utilitarian-type activities are significantly associated with stairway accessibility, slip-resistance measures, greenery, and seating; (4) there is a significant association between nature-exposure activities and layout, greenery, and poor air quality. The findings could guide Chinese officials when renewing ORCs by addressing the most important outdoor environmental factors associated with ODAs.

Walk/wheelability: An inclusive instrument-pair for participatory aging-friendly research and practice

BACKGROUND AND OBJECTIVES

Recent critical evaluations of age-friendly efforts have highlighted the need to prioritize the disenfranchised, including people with mobility limitations. This article examines the validity of a 13-item scale (SWAN13) to measure the "walk/wheelability" of street segments from the perspectives of people with mobility limitations.

RESEARCH DESIGN AND METHODS

Data were drawn from preliminary studies of the Stakeholders' Walkability/Wheelability Audit in Neighborhoods (SWANaudit) which was conducted in two Canadian metropolitan areas. Sixty-one participants who use mobility devices (e.g., walkers, power wheelchairs) and older adults from community organizations audited 195 street segments. We factor analyzed the data from their audits.

RESULTS

SWAN13 has a one-factor structure. Thirteen items were retained from 85 SWANaudit items. SWAN13 encompassed both physical and social aspects of walk/wheelability. The alpha for the scale was .79. Convergent validity was found with the University of Alabama (UAB) Life-Space Assessment (rho=.22, p=.003), especially at the neighborhood level (rho=.23, p=.002). Significant correlation was also found with subjective assessments of a priori walk/wheelability domains (rho=.63, p<.001).

DISCUSSION AND IMPLICATIONS

Walk/wheelability affects the life space of older adults and people with mobility limitations. It is an important latent variable that should be addressed to promote well-being and social participation. SWAN13 may be used in city-wide surveys to identify neighborhoods that may require age-friendly interventions from mobility perspectives. Detailed audits and interventions may be carried out in tandem using the paired SWANaudit instrument. Walk/wheelability is an inclusive and measurable concept that accounts for the needs of people with various mobility needs.

Safety perceptions of older adults on an urban greenway: Interplay of the social and built environment

BACKGROUND

Creating neighbourhood places for older adults to be socially and physically active is a global health priority. Safety is integral to older adult mobility. In greenway research, perceived safety is often only partially or superficially explored. Our study comprehensively examines older adults' experiences and perceived safety for walking on a new urban greenway in Vancouver, Canada-the Arbutus Greenway.

METHODS

We integrated mixed methods: i) observational count data to describe the use and context of the greenway over 3 years (2017; 2018; 2019), and; ii) semi-structured interviews with older adults at two time points (2017, n = 27; 2019, n = 16).

RESULTS

and discussion: We conducted thematic analysis to illuminate older adults' experiences across three safety domains: personal safety, traffic safety, and security. Built environment features such as benches, paving, road markings, and natural foliage buffers intersected with elements of the social environment to influence older adults' perceived safety. While the greenway supported active transportation, leisure, and social engagement for many older adults, certain factors also provoked fears, especially for older adults with mobility limitations. We advocate for a multidimensional lens to better understand how urban interventions influence perceived safety, and identify practical solutions to encourage mobility for all ages and abilities.

Integrating health indicators into urban and transport planning: A narrative literature review and participatory process

Today, urban and transport planners face considerable challenges in designing and retrofitting cities that are prepared for increasing urban populations, and their service and mobility needs. When it comes to health-promoting urban and transport developments, there is also a lack of standardized, quantitative indicators to guide the integration of health components right from the outset, i.e. in the formal planning or zoning phase. We narratively reviewed the literature and organized stakeholder workshops to identify and tailor planning principles and indicators that can be linked to health outcomes. We defined four core planning objectives that previous authoritative studies have suggested to result in positive health outcomes among city dwellers, which are: I) development of compact cities, II) reduction of private motorized transport, III) promotion of active (i.e. walking and cycling) and public transport, IV) development of green and public open space. Built on the review and stakeholder consensus, we identified 10 urban and transport planning principles that work towards achieving the four core objectives thought to provide health benefits for European city dwellers. These 10 planning principles are: 1) land use mix, 2) street connectivity, 3) density, 4) motorized transport reductions, 5) walking, 6) cycling, 7) public transport, 8) multi-modality, 9) green and public open space, and 10) integration of all planning principles. A set of indicators was developed and tailored for each planning principle. The final output of this work is a checklist ready to be applied by urban and transport professionals to integrate health into urban and transport developments in urban environments right from the outset.

My home in later life: A phenomenographic study of older adults' experience of home

Home environments are especially important for older adults whose lives are more home-based than earlier life stages. Despite a focus on ageing in place, there often remains a mismatch between housing options prioritised by government and industry, and the needs and preferences of older adults. This paper considers the breadth of home environments experienced by diverse older Australians and highlights the varied ways they use and think about their homes. Data from three national online focus groups (n1 = 33, n2 = 37, n3 = 33) with people aged 50-92 were analysed using phenomenographic approaches to explore the different ways older adults perceived their home environments, resulting in four hierarchical conceptions. People displayed vastly different lifetime housing pathways (Clapham, 2005), leading to diverse perceptions about the place and experience of home in their later lives. In assessing the suitability of their housing, older people considered a large number of household members: current, expected or desired co-residents; transitory, short, medium and long-term residents; near and extended family, friends and dependents. This has important implications for policy and design responses on older adult's homes, which are typically focussed on occupancy by one or two individuals. To avoid assumptions about household makeup and usage based solely on the chronological age of residents, the perspective of older adults must be embraced in designing their future housing.

Investigating Factors of Active Aging among Chinese Older Adults: A Machine Learning Approach

BACKGROUND AND OBJECTIVES

With the extension of healthy life expectancy, promoting active aging has become a policy response to rapid population aging in China. Yet, it has been inconclusive about the relative importance of the determinants of active aging. By applying a machine learning approach, this study aims to identify the most important determinants of active aging in three domains, i.e., paid/unpaid work, caregiving, and social activities, among Chinese older adults.

RESEARCH DESIGN AND METHOD

Data were drawn from the first wave of the China Health and Retirement Longitudinal Study (CHARLS), which surveys a nationally representative sample of adults aged 60-year-old and above (N=7,503). We estimated Random Forest and the least absolute shrinkage and selection operator (LASSO) regression models to determine the most important factors related to active aging.

RESULTS

Health has a generic effect on all outcomes of active aging. Our findings also identified the domain-specific determinants of active aging. Urban/rural residency is among the most important factors determining the likelihood of engaging in paid/unpaid work. Living in a multi-generational household is especially important in predicting caregiving activities. Neighborhood infrastructure and facilities have the strongest influence on older adults' participation in social activities.

DISCUSSION AND IMPLICATIONS

The application of feature selection models provides a fruitful first step in identifying the most important determinants of active aging among Chinese older adults. These results provide evidence-based recommendations for policies and practices promoting active aging.

What Affects Older Adults' Viewing Behaviors in Neighborhood Open Space: A Study in Hong Kong

Research on older adults' behaviors, living environments, and their quality of life (QoL) has grown rapidly. Viewing behaviors, although broadly acknowledged as critical for older adults' QoL, have not been systematically examined in situ. What affects the viewing behaviors of older adults in neighborhood open space (NOS) is still unclear. This study conducted unobtrusive continuous observations in NOS of two residential estates in Hong Kong. With spatio-temporal analyses with ArcGIS Pro and statistical analyses with SPSS, principal influential factors to viewing behaviors of older adults in NOS were identified, including distances for viewing, landscape attractiveness, body supporting elements, as well as moving and interactive behaviors. How these factors would affect older adults' well-being and QoL is discussed from the perspectives of supportive landscape design, sense of control, prospect and refuge, and social support, etc. Corresponding design implications are proposed to enrich existing NOS design knowledge for older adults' quality of life.

An ecological approach to the development of an active aging measurement in urban areas (AAMU)

BACKGROUND

An essential element in the process of "aging well" is the concept of Active Aging (AA). To propose an operational definition of Active Aging, the present study seeks to develop a new measurement tool through an ecological approach. The aim is to recognize significant indicators that play a role in assessing AA in urban areas.

METHODS

This study was conducted through a two-phase process of consensus-building: 1) identifying a set of indicators that were likely candidates for inclusion based on literature review, and 2) a two-round modified Delphi survey using an international panel of academic experts in environmental sciences and gerontology to achieve consensus on the importance of the extracted indicators and validate the items. The panelists were asked to complete a researcher-developed questionnaire with an 11-point Likert scale based on the indicators derived in phase 1. Finally, the Delphi survey's valid indicators and criteria were utilized to develop the measurement tool.

RESULTS

At the outset, a list of 111 indicators of AA was prepared through the desk study. A panel of 22 experts reviewed the extracted items and arrived at a consensus on 99 items in the first round and finalised in the second round. Thematic analysis of the panelists' open-ended responses revealed new concepts that would be explicitly considered by the consensus group. This developed measurement scale consists of five domains, i.e., individual, spatial, socio-economic, governance, and health-related, which contain 15 criteria and 99 indicators.

CONCLUSIONS

The present researchers have developed the active aging measure for urban settlements (AAMU), which can be used both by policy-makers and as an informal self-reported statement among the elderly. AAM's results in the elderly's residential environmental communities can improve policy-making to address urban design to sustain an active, healthy life among older people in urban environments.

The Participation of Senior Citizens in Policy-Making: Patterning Initiatives in Europe

Worldwide, active aging policy calls for greater participation of senior citizens in the social, economic, and political realms. Despite emerging evidence of initiatives engaging senior citizens in social activities, little is known about the use of participatory approaches in the design and/or implementation of policies that matter to older citizens. This article identifies initiatives facilitating the civic participation of older people in policy-making in European Union member and associate states, drawing on a review of the literature, consultation of national policy experts, and exemplary case studies. Four main patterns of senior civic participation are identified: adopting consultative or co-decisional participatory approaches in policy design or policy implementation. The four are represented to varying degrees at different geographical levels (national, regional, local), with different actor configurations (appointed, elected/nominated, corporate representation), and with varying degree of institutionalization (temporary/permanent). Case studies illustrate approaches taken to enhance the quality and effectiveness of public services for senior citizens. Future research should strengthen this line of enquiry to cast further light on conditions facilitating the civic participation of senior citizens.

Old age and fear of crime: cross-national evidence for a decreased impact of neighbourhood disadvantage in older age

Fear of crime among older people has been a frequent topic in ageing research, criminology and urban studies. The ‘environmental docility hypothesis’ assumes that older people are more vulnerable to adverse neighbourhood conditions than younger age groups. Yet, few studies have tested this influential hypothesis using samples of respondents covering the complete adult lifespan. Looking at fear of crime, we investigated the person–environment interaction of age and neighbourhood disadvantage, using two independent surveys comprising 12,620 respondents aged 25–90 years residing in 435 neighbourhoods in four cities in Germany and Australia. We used multi-level analysis and cross-level interactions to model age-differential effects of neighbourhood disadvantage on fear. Contrary to the hypothesis, we found a weakening of neighbourhood effects on fear with age. The strong effect of neighbourhood disadvantage on fear of crime dropped by around half from the youngest (25 years) to the oldest age (90 years) in both countries. Younger people were almost as fearful as older people in the most disadvantaged neighbourhoods, but older people were considerably more fearful than younger ages in better-off neighbourhoods. We found limited empirical support for the assumption that this diminished association between neighbourhood disadvantage and fear can be explained by the stronger neighbourhood attachment of older people. The limitations of the analysis and potential future directions of research are discussed.

Knowing, Being and Co-Constructing an Age-Friendly Tāmaki Makaurau Auckland

A third of Aotearoa New Zealand’s increasingly ageing population resides in Tāmaki Makaurau Auckland. This most populous cosmopolitan urban area in the country is also home to the largest Polynesian population of any global city. Sprawling across a North Island isthmus inclusive of Hauraki Gulf islands, 70% of the city region is rural, whilst almost 90% of the ethnically diverse residents live in urban areas. Members of Auckland Council’s Seniors Advisory Panel (SAP) advocated for, and in 2018 secured unanimous support from the governing body to resource an Age-friendly City (AFC) Project. This case study inquiry applied bricolage methodology to provide diverse contextual perspectives of this unique Polynesian setting, prior to exploring interview narratives of three SAP members who served two consecutive terms (six years) as AFC advocates. Weaving insights gleaned from their interview transcripts responding to relational leadership prompts about their age-friendly advocacy with the findings from the council’s AFC Community Engagement report highlighted the achievements and challenges of the evolving AFC Project. Service-learning recommendations include co-developing: (1) A sustainable co-governance framework for an independent steering group that embodies the values and principles of Te Tiriti o Waitangi to enable empowered active ageing for all residents; (2) A succession plan that enables the timely transfer of knowledge and skills to empower incoming SAP members.

Measuring the association of objective and perceived neighborhood environment with physical activity in older adults: challenges and implications from a systematic review

BACKGROUND

A supportive environment is a key factor in addressing the issue of health among older adults. There is already sufficient evidence that objective and self-reported measures of the neighborhood environment should be taken into account as crucial components of active aging, as they have been shown to influence physical activity; particularly in people aged 60+. Thus, both could inform policies and practices that promote successful aging in place. An increasing number of studies meanwhile consider these exposures in analyzing their impact on physical activity in the elderly. However, there is a wide variety of definitions, measurements and methodological approaches, which complicates the process of obtaining comparable estimates of the effects and pooled results. The aim of this review was to identify and summarize these differences in order to emphasize methodological implications for future reviews and meta analyzes in this field and, thus, to create a sound basis for synthesized evidence.

METHODS

A systematic literature search across eight databases was conducted to identify peer-reviewed articles examining the association of objective and perceived measures of the neighborhood environment and objectively measured or self-reported physical activity in adults aged ≥ 60 years. Two authors independently screened the articles according to predefined eligibility criteria, extracted data, and assessed study quality. A qualitative synthesis of the findings is provided.

RESULTS

Of the 2967 records retrieved, 35 studies met the inclusion criteria. Five categories of methodological approaches, numerous measurement instruments to assess the neighborhood environment and physical activity, as well as several clusters of definitions of neighborhood, were identified.

CONCLUSIONS

The strength of evidence of the associations of specific categories of environmental attributes with physical activity varies across measurement types of the outcome and exposures as well as the physical activity domain observed and the operationalization of neighborhood. The latter being of great importance for the targeted age group. In the light of this, future reviews should consider these variations and stratify their summaries according to the different approaches, measures and definitions. Further, underlying mechanisms should be explored.

Functioning profiles in a nationally representative cohort of Spanish older adults: A latent class study

Ageing well involves individuals continuing participating in personal, social and civic affairs even in older age. From this standpoint, limitations in individual's functioning (beyond the mere absence of disease) may drastically impact on how well people becoming older. This study aimed to identify functional status profiles in a nationally representative sample of older adults, using latent class analysis methods. Moreover, it intended to study the how identified classes would be related to health-related outcomes later in life, as a way to provide some evidence on predictive validity. Data from a nationally representative sample of Spanish older adults (N = 2,118; 56.18% women; M = 71.50 years, SD = 7.76), were used. Profiles were identified according to a large set of functioning indicators from multiple domains using latent class analysis. Outcomes were studied over a 3-year follow-up, considering both the individual (quality of life, well-being and mortality) and institutional level (health service utilisation). As a result, seven profiles were identified: normative profile (showed by most participants), limited cognitive functioning class, limited global functioning class, limited mental and mobility functioning class, poor self-reported health class, limited sensory functioning class and limited objective functioning class. All the profiles with limitations across domains showed poor outcomes. Multidimensional limitations were related to the worst outcomes, especially when psychosomatic complaints and high feelings of loneliness were reported. To sum up, latent class analysis constitutes a suitable alternative to study population heterogeneity, providing relevant evidence to help making decision in public and community health.

Physical Activity Among Urban-Living Middle-Aged and Older Japanese During the Build-Up to the Tokyo Olympic and Paralympic Games: A Population Study

This research examines physical activity (PA) parameters among urban-living middle-aged and older Japanese during the Tokyo Olympic build-up period. Population sampling was employed, and an online survey was administered with 4,000 adults across Japan's five largest cities. The International Physical Activity Questionnaire-Short Form constituted the main outcome variable, with auxiliary measures of Olympic interest and engagement, readiness for PA behavior change, perceived environmental barriers, and demographic information. Despite interest in the Olympics (>60% moderate-high interest), planned engagement with the event was low (>70% planned passive engagement). Higher levels of interest and planned engagement were both significantly correlated with greater self-reported PA participation (p < .001). Across the sample, the PA levels were in the low-moderate range (990 metabolic equivalent of task-min/week), with significant variations observed by the age-cohort and geographic area (p < .001). Age-cohort and geographic variations were also identified with regard to readiness for PA behavior change and perceived environmental barriers to activity (p < .001). Older age (65 years and above) and host city (Tokyo) residence emerged as correlates of higher levels of PA, greater readiness for behavior change, and fewer reported barriers to participation. These findings have implications for Olympic legacy management and successful transitions from middle age to later life in Japan.

Neighbourhood environment and dementia in older people from high-, middle- and low-income countries: results from two population-based cohort studies

BACKGROUND

A growing number of studies have explored how features of the neighbourhood environment can be related to cognitive health in later life. Yet few have focused on low- and middle-income countries and compared the results across different settings. The aim of this study is to investigate the cross-sectional associations between neighbourhood amenities and dementia in older people from high-, middle- and low-income countries.

METHODS

This study was based on two population-based cohort studies of people aged≥65: the Cognitive Function and Ageing Study II (CFAS II) in UK (N = 4955) and a subset of the 10/66 study in China, Dominican Republic and Mexico (N = 3386). In both cohorts, dementia was assessed using the Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm. The 10/66 dementia diagnostic algorithm was also used as an additional criterion in the 10/66 study. Publicly accessible databases, Google Maps and Open Street Map, were used to obtain geographic information system data on distance to neighbourhood amenities, including lifestyle (cafés, libraries, movie theatres, parks), daily life (post offices, convenience stores), healthcare (hospitals, pharmacies) and percentages of local green and blue spaces within 400 and 800 m of participants' residences. Multilevel logistic regression was used to investigate the associations between these environmental features and dementia adjusting for sociodemographic factors and self-rated health.

RESULTS

Living far from daily life amenities was associated with higher odds of dementia in both CFAS II (1.47; 95% CI: 0.96, 2.24) and the 10/66 study (1.53; 95% CI: 1.15, 2.04), while living far from lifestyle (1.50; 95% CI: 1.13, 1.99) and healthcare amenities (1.32; 95% CI: 0.93, 1.87) was associated with higher odds of dementia only in the 10/66 study. A high availability of local green and blue spaces was not associated with dementia in either cohort yet living far from public parks was associated with lower odds of dementia in CFAS II (0.64; 95% CI: 0.41, 1.00).

CONCLUSIONS

The different relationships across cohorts may indicate a varying role for local amenities in diverse settings. Future research may investigate mechanisms related to these differences and social, cultural and historical influences on the interaction between neighbourhood amenities and older people.

Social Activities and Health-Related Quality of Life in Rural Older Adults in South Korea: A 4-Year Longitudinal Analysis

During later life, inadequate social interactions may be associated with worse quality of life in older adults. Rural older adults are prone to developing unhealthy lifestyles related to social activities, which can lead to a poorer quality of life than that enjoyed by older adults living in urban areas. This study aimed to describe longitudinal changes in social activity participation and health-related quality of life among rural older adults, exploring potential associations with changes to in-person social activity over four years. We used prospective community-based cohort data from the Korean Social Life, Health, and Aging Project (KSHAP) collected between December 2011 and January 2016. The sample included 525 older adults who completed the measure of health-related quality of life. Our results showed a significant change in health-related quality of life according to changes in participation in meeting with friends. Even though an individual's participation in other social activities did not show significant differences in health-related quality of life, our findings imply that in-person social activities may be an important resource to encourage participation in physical activities and to develop other positive outcomes, such as a sense of belonging or satisfaction with later life, among rural older adults.

Older People’s Preferences for Housing and Environment Characteristics

Population ageing presents significant challenges for many countries, one of which is the provision of adequate housing. Developing understanding of the needs and preferences of ageing societies will be crucial in order to assist in the provision of suitable housing and communities that are sustainable in the long term. While a preference to ‘age in place’ is clear in the literature, comparatively less academic research is available on older people’s preferences for more specific housing and environment attributes. The aim of this study is to identify the main housing and environment characteristics that are linked to the health and wellbeing of the elderly and determine the preferences for such characteristics via a survey with UK residents aged 55+. The results indicate a strong preference for independent living and an increasing desire for bungalows in later life. Housing conditions, energy efficiency, thermal comfort, and home adaptions to facilitate ageing in place are particularly important housing characteristics to older people. The location and environment are also key drivers of housing preferences; a safe neighbourhood, accessibility to amenities, public transport, and a clean and walkable environment are particularly important. Preferences varied with age, but gender has a less significant impact on the preferences expressed. The findings of this study will be valuable for stakeholders engaged in housing policy and provision for older people.

[The entanglement of ageing and space in cultural educational programs : The spatial structuring of active ageing at the theater and in the Alps]

BACKGROUND

Even though the effects of cultural activities on active and positive ageing have been extensively examined, spatial aspects have hardly been considered by research in this field.

OBJECTIVES

Instead of understanding active ageing as a result of cultural education, this article focuses on practices of (active) ageing in cultural education programs for older adults. We examined the meanings of space and spatial arrangements in which cultural education takes place and how these spatial aspects limit or enable active ageing.

MATERIAL AND METHODS

The article is based on six qualitative case studies of programs for cultural education for older adults. In programs, such as a yodel seminar or a theater workshop, data were collated by participatory observation and qualitative interviews with the participants and trainers of each program. All data were analyzed using situational analysis.

RESULTS

We found that the spaces where the programs took place had a special meaning to the older participants. This was mainly because these spaces where not exclusively designed for target groups of older adults. The experience of the program was not only characterized by these meanings but also by how these spaces were used within the program. Active ageing was realized through the appropriation of new spaces and specific spatial arrangements.

CONCLUSION

This article shows how spatial arrangements and the experience of (active) ageing are intertwined. To foster active ageing, cultural education programs need to provide spaces which can be used accordingly. For environmental gerontology, this paper highlights the necessity to consider the symbolic dimension of spaces and environments in research.

Aging, Health and Place from the Perspective of Elders in an Inuit Community

This paper explores perspectives of Inuit elders on the relationships between aging, health and place. Their views are important to consider in the context of a growing proportion and number of older people in Arctic communities, a new sociological condition. Developing policies and programs to promote healthy aging in Inuit communities is challenging as there is little known about the social and living conditions that promote healthy aging in the Arctic. In this study twenty Inuit aged between 50 to 86, from one community in Nunavut, participated to in-depth qualitative interviews. Themes discussed included aging and health, housing conditions, community conditions, land-based activities, medical and leisure travel outside of the community, and mobility and accessibility. Preliminary analyses of the qualitative data were validated in the community through a focus group with four participants and an interpreter. Interviews and the focus group transcripts were analysed using thematic content analyses and NVivo 12 qualitative data analysis program (QSR International Pty Ltd. 2017). Participants reported that spending time with children, having social support, living in houses adapted to aging health conditions, having access to community activities and services, and time spent on the land were the main resources supporting their health. Several factors limited the availability of these resources. These include: lack of accessibility to resources; structural factors impacting their availability; and natural and social changes in interpersonal relationships. Participants also stressed the importance of being able to grow old in their own community. Knowledge generated in this project contributes to policies and programs targeting housing and community conditions to support healthy aging, and aging in place, in Inuit Nunangat.

Age-Friendly Communities and Cultural Pluralism: Examining Saskatoon’s Chinese-Canadian Social Enclave

This article uses findings from qualitative interviews to examine the experiences of members of Saskatoon’s Chinese-Canadian older-adult community in terms of their realities of aging and access to important geriatric resources. Promoting an understanding of both group experience and a broader conceptualization of age-friendly development, we argue that the notion and implications of a spatial ethnic enclave are replaced in the Saskatoon context by a social enclave. This network of social support is evident in Chinese-Canadian older adults’ access to housing, recreation, transportation, and health services. The article concludes with lessons learned that would help enhance culturally pluralistic age-friendly development. This work underlines the significance of social capital development within more marginalized older-adult communities, both as a reaction to outside discrimination, and as a means of ensuring healthy and inclusive community aging.

Emerging evolution trends of studies on age-friendly cities and communities: a scientometric review

Population ageing, together with urbanisation, has become one of the greatest challenges throughout the world in the 21st century. Approximately one million people turn 60 each month worldwide. By 2050, more than 20 per cent of the global population is predicted to be 60 years old or above. Thus, an increasing need is evident for age-friendly communities, services and structures. Numerous studies on age-friendly cities and communities (AFCCs) have been conducted over the past decade. The large volume literature makes it necessary to figure out key areas and the evolution trends of studies on AFCCs. Therefore, this paper aims to provide a comprehensive review of existing literature pertaining to AFCCs. A total of 231 collected publications are analysed and visualised by CiteSpace. According to the keywords and document co-citation networks that are generated, the foundation, hot topics and domains of AFCC research are grouped. Three major themes, namely the characteristics of AFCCs, the application of the World Health Organization's framework in urban and rural areas worldwide, and the measurement of cities’ and communities’ age-friendliness, are identified. In addition, a roadmap of AFCC research is developed. The results of this research will therefore benefit researchers and practitioners.