Age-Friendly Cities and Communities: Research to Strengthen Policy and Practice

The impact of transport, housing, and urban development interventions on older adults' mobility: A systematic review of experimental and quasi-experimental studies

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.

Building Back Better: Going Big with Emancipatory Sciences

This commentary argues that precarity and inequity across the life course and aging has accelerated via the COVID-19 pandemic. President Biden's vaccination efforts, $1.9 trillion American Rescue Plan Act, and Build Back Better framework reflect a paradigm shift to restore faith and trust in government that boldly confronts entrenched austerity ideologues. We offer emancipatory sciences as a conceptual framework to analyze and promote social structural change and epic theory development. Emancipatory sciences aim to advance knowledge and the realization of dignity, access, equity, respect, healing, social justice, and social change through individual and collective agency and social institutions. Epic theory development moves beyond isolated incidents as single events and, instead, grasps and advances theory through attempts to change the world itself by demanding attention to inequality, power, and action. Gerontology with an emancipatory science lens offers a framework and vocabulary to understand the individual and collective consequences of the institutional and policy forces that shape aging and generations within and across the life course. It locates an ethical and moral philosophy engaged in the Biden Administration's approach, which proposes redistributing - from bottom-up - material and symbolic resources via family, public, community, and environmental benefits.

Cross-Agency Collaboration to Address Rural Aging: The Role of County Government

Age-friendly community planning and design mainly focus on urban aging and may be less applicable in rural communities. We collaborated with the Tompkins County Age-Friendly Center for Excellence in New York State to assess strategies for rural aging. This commentary argues that density and mixed-use development, as age-friendly development strategies, leave rural communities underserved. County governments, by supporting cross-agency collaboration and encouraging civic engagement, can link the age-friendly domains regarding built environment, service delivery, and community together to help address age-friendly issues and support rural aging.

Serious About Getting Old?: Variability of Individual Old Age Risk Management in Czechia

The global trend of transferring responsibility for dignified aging from the state to individuals is conducive to a variability of alternative attitudes and strategies. Despite having important implications for both the state and individuals, the variability of old age risk management has not been fully appreciated by social policy. Social policy cannot adapt to every individual, but it can reflect various categories of citizens and their patterns of old age risk management. In this article, we navigate the plethora of individual choices by identifying patterns of strategic behavior in old age risk management in society. Based on our data from the original 2018 survey, representative for the Czech population, we identify four distinctive strategies: risk taking, risk avoiding, risk neglecting, and risk preventing. We conclude by discussing how the data gathered and analyzed through our research may help social policy actors better understand sources of variability and design more effective policy interventions.

Creating Age-Friendly Environments in a Smart Society in China: A Policy Review

Technology is increasingly being integrated into Age-Friendly Environments (AFEs). This study explores how technology is manifested in AFE policies in China. We conducted a content analysis of 176 policies spanning seven years to identify the relationship between technology and AFEs and the characteristics of policy development. The findings indicate that technology plays a role in advancing a smart age-friendly society, particularly in terms of enhancing community support and health services and promoting social inclusion. The findings also reveal a list of policy actions and changes in collaborative leadership and strategic priorities throughout policy development. This study emphasizes the need for ongoing policy attention to technology as an integrated component of AFE policies.

Are older people worse off in 2040 regarding health and resources to deal with it? - Future developments in complex health problems and in the availability of resources to manage health problems in the Netherlands

Introduction

Developing sustainable health policy requires an understanding of the future demand for health and social care. We explored the characteristics of the 65+ population in the Netherlands in 2020 and 2040, focusing on two factors that determine care needs: (1) the occurrence of complex health problems and (2) the availability of resources to manage health and care (e.g., health literacy, social support).

Methods

Estimations of the occurrence of complex health problems and the availability of resources for 2020 were based on registry data and patient-reported data. Estimations for 2040 were based on (a) expected demographic developments, and (b) expert opinions using a two-stage Delphi study with 26 experts from policy making, practice and research in the field of health and social care.

Results

The proportion of people aged 65+ with complex health problems and limited resources is expected to increase from 10% in 2020 to 12% in 2040 based on demographic developments, and to 22% in 2040 based on expert opinions. There was high consensus (>80%) that the proportion with complex health problems would be greater in 2040, and lower consensus (50%) on an increase of the proportion of those with limited resources. Developments that are expected to drive the future changes refer to changes in multimorbidity and in psychosocial status (e.g., more loneliness).

Conclusion

The expected increased proportion of people aged 65+ with complex health problems and limited resources together with the expected health and social care workforce shortages represent large challenges for public health and social care policy.