City governments and aging in place: community design, transportation and housing innovation adoption

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).

Accessible independent housing for people with disabilities: A scoping review of promising practices, policies and interventions

BACKGROUND

Accessible housing is imperative to enabling independent living for many people with disabilities; yet, research consistently shows how people with disabilities often lack appropriate accessible housing and are more likely to experience unaffordable, insecure, and/or poor quality housing. Therefore, the aim of this study was to understand promising practices, policies and interventions regarding accessible independent housing for people with disabilities.

METHODS

We conducted a scoping review that involved searching seven international literature databases that identified 4831 studies, 60 of which met our inclusion criteria.

RESULTS

The reviewed studies involved 18 countries over a 20-year period. Our review highlighted the following key trends: (1) removing barriers to obtaining accessible housing (e.g., advocacy, builders enhancing housing supply, subsidies and financial incentives); (2) policies influencing accessible housing; (3) interventions to enhance accessible housing (i.e., home modifications, smart homes, mobile applications and other experimental devices); and (4) the impact of accessible independent housing on health and wellbeing.

CONCLUSIONS

Our findings emphasize the importance of accessible housing for people with disabilities and the urgent need to advance accessible housing options.

Do Age-Friendly Community Policy Efforts Matter in China? An Analysis Based on Five-Year Developmental Plan for Population Aging

(1) Background: The study will examine whether local governments' policy efforts on age-friendly communities (AFC) promote older adults' social participation in China. The extensive scope of AFC makes measuring policy efforts very challenging. The study attempts to introduce the developmental planning and goal-setting theory in public policy literature to answer this question. (2) Methods: We look at the Eleventh Five-Year Developmental Plan for Population Aging in subnational governments and CHARLS (the China Health and Retirement Longitudinal Study) baseline dataset from 2011, with data on policy strength and social participation of older adults. By using multilevel linear models, we regress social participation at the individual level on the policy strength of age-friendly communities at the provincial level. (3) Results: The results show that policy strength on AFC does vary substantially among provinces within China. And the interaction between policy strength of physical environment of local governments and community infrastructures is positively associated with social participation of rural older adults in China. (4) Conclusions: We conclude that policy efforts of local governments on the physical environment of age-friendly communities have effectively promoted the social participation of rural older adults in China. Policy makers could integrate physical infrastructures into their rural revitalization strategy to improve the wellbeing of Chinese older adults.

Aging in Place:

While aging in place is preferred by the vast majority of adults and can bring a host of psychological and physical benefits, older adults require community support in order to age in place safely and with dignity. In this commentary, we review the demographic changes and characteristics of older adults nationally and in Delaware, highlight some of the benefits and challenges to aging in place, and discuss the individual and system-level strategies that are needed to help older adults successfully age in place. Finally, we provide an overview of one creative solution that addresses instrumental and social needs among individuals aging in place with chronic illness.

Adoption of Major Housing Adaptation Policy Innovation for Older Adults by Provincial Governments in China: The Case of Existing Multifamily Dwelling Elevator Retrofit Projects

(1) Background: The housing environment is crucial to the health of older Chinese people and is becoming an urgent policy initiative. This study explores factors that facilitate or impede the adoption of policy innovation on major housing adaptation (HA) by Chinese provincial governments using the framework of policy innovation and diffusion theory. (2) Methods: This study constructs an event history dataset on HA policy related to elevator retrofitting in existing multifamily dwellings in China; the lack of elevators constitutes an insurmountable barrier in older adults’ daily lives in China. The hypotheses were tested by using a traditional event history analysis (EHA) model and a piecewise constant exponential (PCE) model, which is a modified EHA model. The dataset was summarized as “province-year” event history data on 30 Chinese provinces from 2008 to 2019. (3) Results: In addition to internal determinants (e.g., population aging level and financial dependency), diffusion mechanisms can significantly facilitate or impede the adoption of major HA policy innovation by provincial governments. Policy adoption by neighboring governments helps facilitate policy adoption by nonadopters, but policy adoption by subordinate city governments impedes provincial governments’ adoption of major HA policy innovation. (4) Conclusions: This study concludes that provincial governments’ adoption of major HA policy innovation should be given a higher policy priority. The central government can promote provincial governments’ adoption of major HA that primarily benefits older adults by using fiscal transfer payments and enhancing the legitimacy of such policy.

Aligning Policy, Place and Public Value: Planning Age Friendly Cities in Municipal Organizations

KEY POINTS

Age-friendly planning should not fall to local departments of senior services only.Planning coordination of age-friendly policy results in more diverse outcomes.Mapping is a tool helping policy makers visualize alternative opportunities.Maps give stakeholders the ability to track and monitor progress.This approach is easily replicable for cities implementing age-friendly programs.

Aging in the downtown corridor: Mapping the neighborhood experiences of Seattle's unhoused adults over age 50

Research has established the importance of understanding the dynamic relationship between older adults and the environments in which they are embedded. However, the meaning of place for unhoused older adults amidst an increasingly contested urban landscape is largely unknown. This exploratory study aims to further include unhoused older adults' experiences in the scholarship on aging and place by asking how unhoused adults over age 50 (1) describe their spatial patterns and experiences and (2) negotiate their relationship with common urban places. Through iterative mapping conducted in focus groups and interviews at Seattle senior centers, respondents identified how they interacted with their communities and environment. Using inductive and deductive coding of both textual and geospatial data, thematic analysis indicated that respondents: (1) experienced confinement to the downtown corridor and expulsion from surrounding areas- a phenomenon compounded by physical and subjective aging; (2) created routines amidst geographic and temporal restrictions to maximize comfort and security; (3) attempted to create residential normalcy in public places through adaptive and accommodative practices; and (4) experienced identities shaped by movement through and access to place. Current social, spatial, and political contexts of city living present many challenges for older unhoused adults. Supports that ignore people's identification with the places that are important to them are unlikely to be successful. Findings from this paper call for service, policy, and design strategies that facilitate personal agency and connection to place among unhoused people midlife and beyond.

City Government's Adoption of Housing Adaptation Policy Innovation for Older Adults: Evidence From China

OBJECTIVES

Utilizing policy innovation and diffusion theory, this study aims to explain why city governments adopt housing adaptation policies that primarily benefit older people based on the case of China.

METHODS

The data are drawn from an event history data set of a housing adaptation policy for older people collected from 283 Chinese cities from 2010 to 2018. Piecewise constant exponential models are utilized.

RESULTS

The results indicate that cities facing greater internal pressure and a higher political status are more likely to adopt a housing adaptation policy for older people. Policy adoption by neighboring cities could further facilitate this process.

DISCUSSION

Policy innovation and diffusion theory provide a useful framework for this study. That is, the Chinese city government's adoption of housing adaptation policy for older adults is initially driven by local needs and then accelerated by interactions among neighboring governments.

Effect of Social Determinants of Health Interventions on Adults Living with Disabilities: A Scoping Review

OBJECTIVE

To investigate social determinants of health (SDoH) interventions on individual health outcomes, population health, and cost for persons in the United States over age 18 living with disabilities and receiving long-term services and supports (LTSS) in noninstitutional settings.

DATA SOURCES

A review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted of literature from PubMed, PsycINFO, REHABDATA, and Web of Science Core Collection published between January 1997 and July 2020.

STUDY SELECTION

Search terms were based on the primary SDoH domains identified by the Centers for Medicare and Medicaid's Accountable Health Communities Model. A total of 5082 abstracts were screened based on identification criteria of persons age 18 and above living in non-institutional, community-based settings receiving LTSS.

DATA EXTRACTION

During Level 2 review, articles were reviewed based on population focus, type of LTSS (personal assistance services, home care, adult day care, home modification, durable medical equipment, community transition services, caregiver supports and/or prevention services related to home- and community-based care), SDoH intervention and association with health outcomes, population health and/or cost. A total of 1037 abstracts underwent Level 2 review, yielding 131 publications or 1.3% for full review.

DATA SYNTHESIS

Studies (n=33) designed a priori to test outcomes of interventions were rated according to Grading Recommendations Assessment Development and Evaluation (GRADE) criteria. Qualifying articles that did not include interventions (n=98) were included in our summary of the literature but were not assessed by GRADE.

CONCLUSIONS

The preponderance of research surrounding SDoH and health outcomes has focused on older adults living with disabilities, and most interventions scored low or very low using GRADE criteria. Evidence is limited to the extent SDoH interventions are measured against outcomes for persons of all ages living with disabilities. Robust evaluation of models that feature SDoH interventions in partnership with community-based organizations is recommended as home and community-based care infrastructure expands in response to the American Rescue Plan Act of 2021.

Factors Affecting the Intention of Multi-Family House Residents to Age in Place in a Potential Naturally Occurring Retirement Community of Seoul in South Korea

This study reveals residents’ willingness to live in their current homes and communities and analyzes the factors related to their willingness to age in place in South Korea. Using a questionnaire survey method, data of 289 residents aged 55 or older were collected in apartment areas with the potential to become naturally occurring senior communities in Seoul. Data were analyzed using descriptive statistics, correlation tests, t-test, ANOVA, factor analysis, and regression analysis by SPSS 26.0, and the findings were followed up. Housing services are very important in aging communities. Physical environment-oriented residential services promote a safe walking environment, facilities to support the elderly, a secure complex environment, a home-safety accident-prevention diagnosis service, home improvement, and home improvement support. Multiple regression analysis showed that residential services or elderly education and activity support services influence aging in place, which is a novel finding revealed in this study.

Urban Neighborhood Characteristics and the Spatial Distribution of Home and Community-Based Service Organizations in Michigan Metropolitan Statistical Areas

Living in a neighborhood with dense HCBS organizations can promote older adults' health and well-being and may mitigate health disparities generated by living in materially deprived urban neighborhoods. Using 2016 US County Business Patterns and the American Community Survey (2013-2017), focused on 516 ZIP Codes in Michigan Metropolitan Statistical Areas, this study examines the association between neighborhood characteristics and the relative density of businesses offering services for older adults and persons with disabilities (e.g., senior centers, adult day service centers, personal care) and businesses offering home health care. Results from a series of spatial econometric models show that social care organization density tends to be high in neighborhoods with a greater number of residents who have a bachelor's degree, who are older, and who are in poverty. Home health care density was not explained by neighborhood factors. Multiple neighborhood socio-demographic indicators explain the spatial distribution of social care organizations.

The planning and reporting of mixed methods studies on the built environment and health

Researchers examining the influence of the built environment on health are increasingly using mixed methods approaches. The use of more than one type of methodology to address a single research question is compelling in this field because researchers investigating the impact of the built environment on health have been faced with proposing solutions to a complex societal problem involving interacting systems and social uncertainties. Mixed methods studies can help researchers to gain a better understanding of the relationships that exist between humans and their environment by drawing on qualitative and quantitative methods. Mixed methods studies could also be instrumental for providing effective policy solutions. This is because they allow researchers to identify built environment determinants of health in a population of interest and to understand the social and cultural factors that might influence the uptake of an intervention by this population. The objective of this paper is to assist those conducting research on the built environment and health who may have little background in mixed methods. We provide an overview of mixed methods research designs and provide concrete techniques for the integration of diverse methods. We also discuss the recommendations for mixed methods research in the field of built environment - health research, drawing on specific examples from published studies. Reporting a research design and an integration strategy in mixed methods studies could help to strengthen our ability to gain new insights into the multidimensional nature of the relationship between the built environment and health.

Generational Distinctions on the Importance of Age-Friendly Community Features by Older Age Groups

In 2006, the World Health Organization initiated an international movement to enhance active aging and the age-friendliness of communities by focusing efforts on the built, social, and service environment. The global model requires soliciting older adults’ preferences regarding community features although findings are typically aggregated across all aged respondents despite mounting distinctions between the generations. This study aimed to examine the differential salience of community features by older generational age groups including Baby Boomers ( n = 639) and Silent and Government or General Issued (GI) Generation ( n = 488) in an age-friendly community in which more than half of its residents are age 50 or older. Chi-square results indicate significant differences across the generational age groups in all domains with the greatest distinctions pertaining to preferences in housing, outdoor spaces, employment, and participation in varied social activities. The perceptions expressed by Boomer-aged adults portend implications ahead for multiple sectors and features of community life.

Promises and pitfalls of integrating home-based health services into Shanghai's elder-care system

Faced with the dramatic pace of population ageing, the Shanghai municipal government launched a pilot programme in 2013 designed to address this and to strengthen ageing-in-place arrangements by providing basic in-home medical services for residents above the age of 80. Yet after a two-year trial run, the ‘Home-Based Medical Care Scheme for the Oldest-Old’ (HBMCSOO) policy remained significantly under-utilised despite the increasing demand for medical services. Our multi-disciplinary research team of social workers and anthropologists identified two key factors impeding the implementation of home-based medical care services: (a) the distortion of policy implementation and (b) the inadequate professionalisation of community-based elder-care workers. Based on our evaluation of the pilot programme, the Shanghai municipal government made several practical adjustments to improve the subsequent city-wide policy implemented in 2016. While these changes mostly focused on minor adjustments to improve in-home medical services for the oldest-old, they represent an encouraging first step towards our call for a holistic integrated care system whose design and delivery takes into account local political and social contexts, including existing institutional infrastructure and cultural expectations about care-giving responsibilities. The challenges of implementing Shanghai's HBMCSOO policy ultimately provide instructive lessons on best practices for integrating medical and social services in order to improve ageing-in-place measures in diverse local settings around the world.

Links between social environment and health care utilization and costs

The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.

Aging in Place

Aging is a function of time and is a natural and integral part of the life cycle. Aging process differs among individuals and brings all kinds of changes, affecting not just the physical body and its functions, but also to the social, psychological and financial situations to individuals. Aging in place (AIP) is a common preference among older people for remaining in their local community and maintaining their social networks throughout the aging process. Issues about appropriateness of aging in place, long-term care, and residential homes are discussed. Some models and recommendations are discussed, completed with thoughts on future studies.

Supporting Aging-in-Place Well: Findings From a Cluster Analysis of the Reasons for Aging-in-Place and Perceptions of Well-Being

Prior research on gerontology and housing has frequently adopted a perspective that aging-in-place is the "goal." Despite these meaningful results and policy implications, opportunities to explore consequences of aging-in-place, such as the association of this with overall well-being, have been overlooked. This study aims to fill this gap by investigating perceptions of well-being that could act as a driver or result of aging-in-place. With a nationwide random sample of non-Hispanic White, older individuals (60+), living in their homes (N = 328), three segments of senior residents based on their reasons for aging-in-place were identified. Results reinforce the importance of community-based integrative programs and policies by indicating that the three identified clusters were not homogeneous; however, inclusive community-based supports and services can provide what each cluster needs to successfully age-in-place. Discussion provides a perspective on how to support successful aging-in-place, including the role of the federal government in funding and legislation.

Living in your own home and being socially connected at 95 years and beyond: a qualitative study

BACKGROUND

Being socially connected is linked to positively influencing older people's ability to remain living in their own homes and has shown to support independence and enhance well-being.

AIM

To explore how individuals aged 95 years and older living in their own home remain socially connected.

METHODS

Informed by a critical gerontological approach, semi-structured interviews with eight women and two men aged between 96 and 100 years were undertaken. Following transcription, data were thematically analysed.

RESULTS

Three main themes illuminating social connectedness were identified: "Keeping company: staying connected with family and friends", "Doing things together: engaging with paid and unpaid helpers" and "Having pride and enjoyment: continuing with hobbies and interests".

CONCLUSION

It is important that health professionals and social service providers recognise the importance of social connectedness, and provide a range of options to support continuing social connectedness and community engagement for older people.

Optimizing mobility in later life: the role of the urban built environment for older adults aging in place

Hazards in the urban built environment can create barriers to mobility among older adults aging in place. We investigated the relationship between urban built environment characteristics and 15-month trajectories of mobility disability in a sample of 1,188 older adults living in Detroit, MI, a city that has undergone rapid economic and structural decline. Data come from the Michigan Minimum Data Set for Home Care (2001-2008), an enumerative database of older adults in Michigan who qualify for federal or state-funded home and community-based long-term care through a Medicaid waiver program. Standardized assessments are made at intake and every 90 days by case managers. Built environments were assessed with a virtual audit using the "Street View" feature of Google Earth. A summary accessibility score was created for each block based on a count of the number of accessible features (e.g., continuous barrier-free sidewalks and proximity of public transportation). Using growth mixture models, two latent trajectories of outdoor mobility were identified: one capturing occasional outdoor mobility (representing 83 % of the sample) and one capturing almost no mobility outside the home. Controlling for sociodemographic and health risk factors, individuals living in more accessible environments had a 18 % higher odds of being in the more mobile group (OR = 1.18, 95 % CI = 1.01, 1.41). These findings emphasize the importance of the built environment for mobility among urban-dwelling older adults.

Relocation remembered: perspectives on senior transitions in the living environment

The experience of aging may necessitate transitions in living environments, either through adaptations to current residences or through relocations to more supportive environments. For over a half century, the study of these transitions has informed the work of researchers, health and mental health providers, policymakers, and municipal planners. In the 1970s and 80s, knowledge about these transitions advanced through Lawton and Nahemow's ecological theory of competence and environmental press, Wiseman's behavioral model of relocation decision making, and Litwak and Longino's developmental perspective on senior migrations. This article revisits influential theoretical frameworks that contribute to our understanding of senior transitions in living environments. These seminal works are shown to inform recent studies of relocation and gerontology. This article concludes with a call for a view on housing transitions that reflects the contemporary context.

Ageing-friendly communities and social inclusion in the United States of America

Synthesising the social capital and ageing-friendly communities literature, this paper describes how efforts to make communities more ageing-friendly can promote social inclusion among older adults. Making existing communities more ageing-friendly involves physical and social infrastructure changes that enable older adults to pursue lifelong activities, meet their basic needs, maintain significant relationships, participate in the community in personally and socially meaningful ways, and develop new interests and sources of fulfilment. Such efforts can enhance bonding, bridging and linking capital, and thereby promote social inclusion. The authors discuss the link between ageing-friendly communities and social inclusion, and provide examples of programmes with potential to change existing communities into ones that promote the social inclusion of older adults.

Aging in community: mobilizing a new paradigm of older adults as a core social resource

Dignity and independence are widely considered as core concepts to aging well, yet little research has explored how older adults perceive these issues in the context of community life. Moreover, little is known regarding the ways in which the broader public views and enhances aging with dignity and independence with their older residents. Using participatory action research, multiple methods of qualitative inquiry, and tenets of appreciative inquiry, this article reports on a community-based initiative aimed to better understand the positive aspects of aging with dignity and independence. Synthesized findings yielded 6 "actionable themes": (1) meaningful involvement, (2) aging in place, (3) respect and inclusion, (4) communication and information, (5) transportation and mobility, and (6) health and well-being. The findings invoke a new paradigm for community aging that highlights the unique contributions of older adults as a core social resource. Implications for mobilizing community action to promote aging with dignity and independence are discussed.