Age-friendliness of living environments from the older person's viewpoint: development of the Age-Friendly Environment Assessment Tool

Construction and improvement strategies of an age-friendly evaluation system for public spaces in affordable housing communities: a case study of Shenzhen

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.

What Does It Mean to "Age Well" Among British and Javanese Older Adults? A Cross-Cultural Qualitative Study

OBJECTIVES

This study aimed to investigate perceptions of what it means to "age well" and to explore similarities and differences between a Western and non-Western culture (Britain and Java).

METHODS

Qualitative interviews explored how Javanese and British older adults defined aging well, establishing the similarities and differences between cultures. Javanese (n = 14) and British (n = 15) adults aged 61-80 (mean age = 68) participated. The data were analyzed using reflexive thematic analysis and organized with NVivo.

RESULTS

Four themes were identified that captured what it means to age well across cultures: (a) good health is a springboard for aging well; (b) holding a positive outlook is a decisive factor in aging well; (c) "having enough" and "feeling safe" provide peace of mind; and (d) spirituality and religiosity provide tranquility. Although both cultures mentioned similar factors, there were variations in the interpretations and emphasis within themes. For example, Javanese participants emphasized the importance of the social environment whereas British participants highlighted the physical environment.

DISCUSSION

Differences between cultures are important for understanding how best to support people as they age. For example, in Java, aging well may be best supported by providing a vibrant social environment. For people in Britain, having a safe and secure physical environment may be more important.

Using the Age-Friendly Environment Framework to Assess Advance Care Planning Factors Among Older Adults With Limited Income: A Cross-Sectional, Descriptive Survey Study

BACKGROUND AND OBJECTIVES

The World Health Organization created the Age-Friendly Environment (AFE) framework to design communities that support healthy aging and equitable decision making. This framework's resource domains may account for disparately lower advance care planning (ACP) among older adults with limited incomes compared to those with high incomes. We aimed to describe and examine associations of AFE factors with ACP.

RESEARCH DESIGN AND METHODS

We recruited and conducted cross-sectional surveys among older adults with limited incomes in 7 community-based settings in Nashville, TN. ACP and AFE item scales were dichotomized and analyzed with unadjusted phi correlation coefficients.

RESULTS

Survey participants (N = 100) included 59 women, 70 Black/African American, and 70 ≥60 years old. Most participants agreed that their community was age friendly (≥58%) and varied in ACP participation (22%-67%). Participants who perceived easy travel and service access and sufficient social isolation outreach were more likely to have had family or doctor quality-of-life discussions (phi = 0.22-0.29, p < .05). Having a healthcare decision maker was positively associated with age-friendly travel, housing, and meet-up places (phi = 0.20-0.26, p < .05).

DISCUSSION AND IMPLICATIONS

The AFE framework is useful for exploring the environmental factors of ACP, but further research is warranted to identify specific and immediate resources to support successful ACP among populations with socioeconomic disadvantage.

Examining dynamic developmental trends: the interrelationship between age-friendly environments and healthy aging in the Chinese population-evidence from China Health and Retirement Longitudinal Study, 2011-2018

BACKGROUND

The objective of this research is to investigate the dynamic developmental trends between Age-Friendly Environments (AFE) and healthy aging in the Chinese population.

METHODS

This study focused on a sample of 11,770 participants from the CHARLS and utilized the ATHLOS Healthy Aging Index to assess the level of healthy aging among the Chinese population. Linear mixed model (LMM) was used to explore the relationship between AFE and healthy aging. Furthermore, a cross-lagged panel model (CLPM) and a random-intercept cross-lagged panel model (RI-CLPM) were used to examine the dynamic developmental trends of healthy aging, taking into account both Between-Person effects and Within-Person effects.

RESULTS

The results from LMM showed a positive correlation between AFE and healthy aging (β = 0.087, p < 0.001). There was a positive interaction between the geographic distribution and AFE (central region * AFE: β = 0.031, p = 0.038; eastern region * AFE: β = 0.048, p = 0.003). In CLPM and RI-CLPM, the positive effect of healthy aging on AFE is a type of Between-Person effects (β ranges from 0.147 to 0.159, p < 0.001), while the positive effect of AFE on healthy aging is Within-Person effects (β ranges from 0.021 to 0.024, p = 0.004).

CONCLUSION

Firstly, individuals with high levels of healthy aging are more inclined to actively participate in the development of appropriate AFE compared to those with low levels of healthy aging. Furthermore, by encouraging and guiding individuals to engage in activities that contribute to building appropriate AFE, can elevate their AFE levels beyond the previous average level, thereby improving their future healthy aging levels. Lastly, addressing vulnerable groups by reducing disparities and meeting their health needs effectively is crucial for fostering healthy aging in these populations.

A multi-year quantitative study of the experienced age-friendliness in The Hague: A tale of four personas

As an active member of the Global Network for Age-Friendly Cities and Communities, The Hague has been monitoring the progress over the years. In 2022, a second cross-sectional survey based on the Age Friendly Cities and Communities Questionnaire (AFCCQ) was conducted among 396 community-dwelling older citizens in the municipality. During times of the pandemic, scores for Social Participation went notably down, and scores for Respect and Social Inclusion increased. For the first time, based on survey data, four personas were found through cluster analysis. These personas ranged from the precariat and people with personal health issues with lower scores, to the silent majority without the limitations of health problems, and the upper echelon who score positively in all domains. Age-friendly policies in The Hague should focus particularly on the first two clusters through dedicated action plans, which would help steer efforts towards those most in need for support. This would help The Hague to become an age-friendly city for all, and not only for those living in good health and with sufficient financial means.

Rural age-friendly ecosystems for older adults: An international scoping review with recommendations to support age-friendly communities

Background and Aims

The population of older adults in rural areas is rising, and they experience higher rates of poverty and chronic illness, have poorer health behaviors, and experience different challenges than those in urban areas. This scoping review seeks to (1) map the state of the science of age-friendly systems in rural areas regarding structural characteristics, processes for delivering age-friendly practices, and outcomes of age-friendly systems, (2) analyze strengths, weakness, opportunities, and threats of age-friendly system implementation, and (3) make person, practice, and policy-level recommendations to support active aging and development of age-friendly communities.

Methods

An international scoping review was conducted of articles that used age-friendly framing, had a sample age of 45 years of age or older, self-identified as rural, and reported empiric data. Searches were conducted in PubMed, CINAHL, AgeLine, PsychINFO, EMBASE, Scopus, and Academic Search Elite on October 26, 2021, and rerun March 10, 2023. Data were charted across three analytic layers: socioecological model, Donabedian's framework, and SWOT analysis.

Results

Results reveal limited data on outcomes relevant to organizations, such as return on investment or healthcare utilization. While the SWOT analysis revealed many strengths of age-friendly systems, including their impact on persons' outcomes, it also revealed several weaknesses, threats, and gaps. Namely, age-friendly systems have weaknesses due to reliance on trained volunteers and staff, communication, and teamwork. System-level threats include community and health system barriers, and challenges in poor/developing areas.

Conclusions

While age-friendly systems in this review were heterogeneous, there is an opportunity to focus on unifying elements including the World Health Organization age-friendly cities framework or 4Ms framework for age-friendly care. Despite the many benefits of age-friendly systems, we must acknowledge limitations of the evidence base, pursue opportunities to examine organizational metrics to support implementation and sustainability of age-friendly systems, and leverage improvements in age-friendliness at a community level.

Toward Age-Friendly Policies: Using the Framework of Age-Friendliness to Evaluate the COVID-19 Measures from the Perspectives of Older People in the Netherlands

Protective measures that were taken during the COVID-19 pandemic, targeted older people as an at-risk group. The objective of this article is to investigate how older people in the Netherlands experienced the mitigation measures and whether these measures endorse and promote the idea of an age-friendly world. The WHO conceptual framework of age-friendliness, which consists of eight areas, has been used for a framework analysis of 74 semi-structured interviews with older Dutch adults, that were held during the first and the second wave of the pandemic. The results of the analysis indicate that the areas of social participation, respect and inclusion were affected most, and the measures concerning communication and the health services were experienced as age-unfriendly. The WHO framework is a promising tool for assessment of social policies, and we suggest its further development for this purpose.

Digital Health Service for Identification of Frailty Risk Factors in Community-Dwelling Older Adults: The SUNFRAIL+ Study Protocol

This article reports the study protocol of a nationwide multicentric study in seven Italian regions aimed at assessing the effectiveness of a digitally supported approach for the early screening of frailty risk factors in community-dwelling older adults. SUNFRAIL+ is a prospective observational cohort study aimed at carrying out a multidimensional assessment of community-dwelling older adults through an IT platform, which allows to connect the items of the SUNFRAIL frailty assessment tool with a cascading multidimensional in-depth assessment of the bio-psycho-social domains of frailty. Seven centers in seven Italian regions will administer the SUNFRAIL questionnaire to 100 older adults. According to the answers provided by older adults, they will be subjected to one or more validated in-depth scale tests in order to perform further diagnostic or dimensional evaluations. The study aims to contribute to the implementation and validation of a multiprofessional and multistakeholder service model for the screening of frailty in community-dwelling older adult population.

Developing Indicators of Age-Friendliness in Taiwanese Communities through a Modified Delphi Method

This study developed indicators of age-friendliness for communities in Taiwan that conform to international standards by referring to the World Health Organization Checklist of Essential Features of Age-Friendly Cities and Taiwan's existing indicators. The first stage of the research was based on the WHO's framework and involved a literature review to identify candidate indicators. In the second stage, experts' opinions were collected through a modified Delphi method, and the indicators were screened and revised on the basis of their importance, community enforceability, and generality. The third stage focused on practical feasibility. External parties were invited to offer their opinions regarding the indicators, which were adjusted accordingly. After three rounds of review and re-examination based on the modified Delphi method, the final set of indicators comprised five core indicators and five optional indicators. These indicators can be used to monitor various aspects of communities and determine their age-friendliness.

An observational cohort study of longitudinal impacts on frailty and well-being of COVID-19 lockdowns in older adults in England and Spain

To reduce the spread of COVID-19, governments initiated lockdowns, limiting mobility and social interaction of populations. Lockdown is linked to health issues, yet the full impact on health remains unknown, particularly in more vulnerable groups. This study examined the impact on frailty and outcomes in high and low COVID-19 risk older adults. We examined health-related behaviours and support resources participants used during lockdown(s). Lockdown impacts in two countries were compared across four time points to examine impacts of different rules. We recruited 70 participants (aged >70 years) in England and Spain. Participants were allocated to higher or lower COVID-19-risk groups based on UK NHS guidelines. They completed assessments for frailty, quality-of-life, loneliness, exercise frequency and social interaction, coping resources and perception of age-friendliness of their environment. The four assessments took place over a 7-month period. Frailty was highest at Time 1 (most severe lockdown restrictions) and significantly higher in the Spanish group. It was lower at Time 3 (lowest restrictions), but did not continue to reduce for the English participants. Perceptions of the age friendliness of the environment matched these changes. Coping resources did not mitigate changes in frailty and outcomes over time, but more frequent physical activity predicted more reduction in frailty. Lockdown had a negative impact on frailty, increasing risk of adverse events for older people, but recovery once lockdowns are eased is evidenced. Further research is required to consider longer term impacts and methods to mitigate effects of lockdown on health.

Assessment of Environmental Demands of Age-Friendly Communities from Perspectives of Different Residential Groups: A Case of Wuhan, China

Age-friendly communities (AFCs) are an important measure for fostering active aging. The key to achieving an age-friendly living environment is to construct or renovate it according to the residents’ demands. To date, very few studies have attempted to delve into the AFCs’ environmental demand from different groups’ perspectives. Based on the theory of place attachment, the aim of this paper is to explore the demand diversity of different groups for the AFC environment. This study employs the nonparametric test and the Ordinal Priority Approach (OPA) to investigate the demands from the residents’ perspectives, and is enhanced by incorporating experts’ opinions. The empirical analysis shows that residents have a high level of demand for the physical environment (indoor and outdoor) and social environment (community services and social participation). At the same time, experts advocate the importance of using digital technologies to support people aged 45–65 who have higher requirements for a community environment than older adults. The findings also show that other backgrounds, such as gender, living arrangements, and year of the community establishment, lead to different demands. However, the impact of residents’ education level, occupation, income, and self-care ability on the environmental demands is low. Based on the research findings, the paper provides some practical suggestions for the future design and development of AFCs.

Living with pain in 'age-(un)friendly' housing environments: A qualitative study with African American older adults

Understanding the dynamic relationship between housing environment and older adults' pain may identify important factors that influence disparities in later life. We used a qualitative description approach to examine the context of environmental lifespaces in older African Americans (ages 61-81) with chronic osteoarthritis pain living in income-adjusted housing. Environmental inequity, healthcare needs, and mobility limitations influenced their perceptions of lifespace equity and interfered with their vitality and feeling of security. Their housing environments lacked age-friendly amenities, and specific enhancements to assist aging individuals with everyday function and reduction of pain were identified. This study contributes new evidence on the impact of macro, meso, and micro environments on pain management while also calling for greater attention to parity in infusing age-friendly resources into minority housing.

Measurement Indicators of Age-Friendly Communities: Findings from the AARP Age-Friendly Community Survey

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.

Assessing Age-Friendly Community Progress: What Have We Learned?

BACKGROUND AND OBJECTIVES

The Global Network of Age-friendly Cities and Communities has grown steadily over the past decade across the United States. The age-friendly model calls for a five-year process of continuous improvement across the stages of engagement, planning, action and measurement, culminating in an evaluation of age-friendly progress. However surprisingly little is known regarding American age-friendly communities' accomplishments to date.

RESEARCH DESIGN AND METHODS

We utilized content analysis to assess the progress reported by American age-friendly communities (n = 30) that joined by end of year 2015 using the Age-Friendly Community Evidence-based Tool with expanded program evaluation measures including health equity as defined by the World Health Organization. We employed deductive analytic techniques to assess reported community performance in eleven thematic areas across the range of structures and processes that characterize age-friendly efforts.

RESULTS

We found strong evidence in the areas of leadership and governance, harnessed resources, application of age-friendly framework and in multisector collaboration as well as reported provisions. All of the communities reported health equity aims, particularly in promoting accessible physical environments and social inclusion efforts. Our analysis further revealed relatively moderate evidence of older adult involvement and weak performance in the monitoring and reporting of evaluative findings as well as overall summation and dissemination plans.

DISCUSSION AND IMPLICATIONS

We conclude by synthesizing the overall performance reported by the age-friendly communities, highlighting both strengths and weaknesses. We also offer suggestions to enhance evaluative efforts and advance the dissemination of age-friendly community progress.

Examining Older Adults' Perspectives on the Built Environment and Correlates of Healthy Aging in an American Age-Friendly Community

Population aging has led to an increased focus on the environmental context in which we age. While researchers have identified significant health benefits associated with built community features such as housing, transportation and outdoor spaces and buildings, less attention has focused on the correlates of healthy aging and other characteristics via the perspective of community-dwelling older adults. This study utilized cluster analysis to examine health-related subgroups of older adults (n = 598) in an age-friendly community located in the United States, of which nearly half of its residents are age 60 and older. Linear regression was used to associate the health clusters with perceptions of built environmental features and socio-demographics. Four distinct profiles were identified, with the greatest preference for housing and transportation found among those reporting poorer health compared to those reporting excellent health across multi-dimensional healthy aging measures. Perceptions on the importance of built environmental features were also found to vary by age, income and home accessibility status. Findings suggest that older adults’ perceptions about built environmental features differ across health and home status as well as age and income, underscoring opportunities for public health action to better reach and engage older adults by life-course trajectories in age-friendly communities.

How Older People Experience the Age-Friendliness of Their City: Development of the Age-Friendly Cities and Communities Questionnaire

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.