Livable Environments and the Quality of Life of Older People: An Ecological Perspective

The Relationships Among Family Functioning, Sleep Quality and Quality of Life in Chinese Community-Dwelling Older Adults with Insomnia: A Structural Equation Model

OBJECTIVES

The proportion of individuals with insomnia is increasing, and many older adults have insomnia. This study aimed to explore the relationships between family functioning and quality of life (QOL) among community-dwelling older adults with insomnia, as well as to explore the mediating role of sleep quality in this relationship.

METHODS

The participants were 225 older adults with insomnia from community health service centers in Chongqing, China. The Family Care Index (APGAR) was used to assess family functioning, the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and the 36-item Short-Form Health Survey (SF-36) was used to assess QOL.

RESULTS

The results showed that family functioning would be positively associated with QOL (p = .005) and that this relationship would be partially mediated by higher sleep quality (p < .001).

CONCLUSIONS

Family functioning has a direct effect on QOL and an indirect effect on QOL through the regulation of sleep quality. Maintaining good family functioning is important for improving sleep quality and QOL in older adults with insomnia.

CLINICAL IMPLICATIONS

Developing family functioning-based assessments and targeted intervention strategies could be beneficial for older adults with insomnia.

Investigating the measurement properties of livability: a scoping review

Connecting evidence-based public health recommendations to livability, a popular and relatable construct, can increase the policy relevance of research to improve community design. However, there are many different definitions and conceptualizations of livability and little consensus about its measurement. Improved measurement, including standardization, is needed to increase understanding of livability's influence on health and to facilitate comparisons across contexts. This study sought to review existing livability measures, how they were created, and evidence regarding their reliability and validity. A scoping review of three databases (PubMed, Google Scholar, and Web of Science) identified 744 eligible studies. After screening, 24 studies, 15 from the original search and 9 through backward citation searches, were included in the review. Most studies were carried out in an urban context. There was minimal consensus across studies on the conceptualization of livability. However, measure domains and indicators overlapped significantly. While the process used to validate the measures varied, most studies reported high levels of reliability and found that livability was correlated with similar measures (e.g. place satisfaction, neighborhood safety, and sense of place) and self-reported health and wellbeing. Further research is needed to develop parsimonious, standardized measures of livability in order to create and sustain livable communities worldwide.

Ageing in Context: An Ecological Model to Understand Social Participation Among Indigenous Adults in Chile

The social participation of older adults occupies a central position in international discourse regarding ageing, the ecological model makes it possible to examine and assess the different factors that influence the understanding of what encourages social participation by older adults. This study used the ecological model to analyse how personal, community and environmental factors are related to satisfaction with social participation among Chilean older adults, a majority of whom are indigenous, living in rural areas (n = 800). The results confirmed that satisfaction with social participation was related to personal factors (feelings of depression, functioning into basic activities of daily living (ADL) and autonomy), community factors (perceived social support from social group) and environmental factors (accessibility of physical setting within the village). Our findings confirmed a high level of social participation among indigenous adults, with rural and indigenous surroundings appearing to be a factor that protects and promotes social integration.

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.

A Meta-Analysis on the Influence of Age-Friendly Environments on Older Adults' Physical and Mental Well-Being

The importance of age-friendly environments (AFEs) for older adults has been empirically and theoretically highlighted by the extant literature. However, the strength of the association between environments and older adults’ well-being has not been comprehensively quantified. Given the different attributes of the physical and mental dimensions, this meta-analysis aims to synthesise and quantify the association between AFEs and the physical and mental well-being of older adults. Fourteen eligible studies were included in this analysis: among which eight explored the link between AFEs and physical well-being, and eleven investigated AFEs in association with mental well-being. A random-effects model showed a small but significant correlation between AFEs and the mental well-being of older adults (r = 0.160, 95% CI [0.084, 0.224], p < 0.001), and the correlation between AFEs and physical well-being was also significant (r = 0.072, 95% CI [0.026, 0.118], p < 0.01). The number of environmental factors involved in AFEs moderated the association with physical well-being, from which the association was only significant among studies focusing on fewer environmental factors (n < 6). Results of this meta-analysis indicated that AFEs may be more effective in promoting the emotions of older adults, compared to ameliorating their physical functioning. The limitations of current empirical studies and directions for future research in the field of environmental gerontology were also discussed.

Conceptualising relevant social context indicators for people receiving home care: A multi-method approach in Flanders, Belgium

Despite an increasing awareness of the impact of the social context of a person on personalised care planning, there is currently no generally accepted classification of social context. As a result, home care professionals have a partial understanding of what social context is and how it affects and can even benefit their work. In this study, we define the main themes and concepts of the social context in the home care setting. The goal in this study is twofold. Initially, we want to offer a multidimensional and practical model of social context, founded on the perspectives of care users and professional caregivers in home care. This model of social context, in turn, will be the foundation for the development of a Social Supplement for the interRAI assessment instruments. We conducted nine focus groups in Flanders between September and November 2017. Fifty-four people participated. The focus groups followed a semi-structured format based on themes identified from the literature and three in-depth interviews with experts. Questions focused on defining the main themes of 'social context' and their subcategories. At the end of each discussion, participants were asked to consider which concept could be suitable and essential for a Social Supplement to the current interRAI instruments. Focus groups were recorded, transcribed and analysed using NVivo. We used investigator and theoretical triangulation to ensure the quality of our analysis, and identified five overarching themes of social context; (a) care and support, (b) physical environment, (c) life and care goals, (d) psychosocial well-being and (e) civic engagement. These main themes were mentioned throughout the nine focus group discussions, even though a diverse group of stakeholders participated. This model provides the basis for the development of a Social Supplement for the interRAI assessment instruments in Flanders, Belgium.

Older People's Neighbourhood Perceptions are Related to Social and Emotional Loneliness and Mediated by Social Network Type

BACKGROUND AND OBJECTIVES

Loneliness among older people is a public health issue, however, there is very weak support for the efficacy of individually focussed interventions. A public health model which includes the environmental influence on formation of social networks and protection from loneliness, and theoretical approaches differentiating between social and emotional loneliness, suggest the importance of neighbourhoods in preventing loneliness. This approach was used to test the influence of neighbourhood factors on loneliness and the mediating role of social networks.

RESEARCH DESIGN AND METHODS

A questionnaire survey of 917 people aged 60 to 100 years was conducted in one region of Aotearoa/New Zealand to assess loneliness, social network types, social participation, marital status, gender, health and four aspects of neighbourhood perceptions.

RESULTS

Social and Emotional Loneliness scores were regressed on predicted demographic and social variables followed by perceptions of Housing Satisfaction, Neighbourhood Accessibility, Neighbourhood Security, and Neighbourhood Social Cohesion. Neighbourhood variables added significant explanation of variance in both Social and Emotional Loneliness. Mediation tests using PROCESS showed that the effects of all neighbourhood variables were mediated by Private Restricted or Locally Integrated Network types on Social Loneliness only.

DISCUSSION AND IMPLICATIONS

These findings highlight the importance of neighbourhood factors in relation to feelings of loneliness and the recognition of social network types as mediators of these relationships for social loneliness. The aspects of neighbourhoods that prevent loneliness provide directions for planners and prevention programmes. Interventions to prevent social loneliness can usefully and practicably focus on the housing and neighbourhood environment.

Do Home and Community Environments Explain Self-Rated Health Among Older Canadians? Evidence From the 2018 Canadian Housing Survey

OBJECTIVES

This study examined the associations between home and community environmental factors and self-rated health (SRH) among older Canadians and how these associations vary by gender and living arrangements. Background: In social gerontology research, the psychosocial determinants of SRH have been widely investigated. Based on the environmental gerontology framework, this study examined the home and community environmental correlates of SRH.

METHOD

The sample (aged 60 or older) was drawn from the 2018 Canadian Housing Survey (4,086 men living alone; 6,471 men living with others; 9,170 women living alone; 4,876 women living with others). Multiple regression analyses were used to examine the relationships between SRH and potential environmental correlates in a hierarchical model.

RESULTS

Findings show that older men and women living alone reported lower levels of SRH than those living with others. Regression findings show common and unique home and community environmental predictors of SRH by group. Common predictors of higher SRH were private housing residence, larger living space, satisfaction with dwelling, volunteering, no perceived need for community services, and community safety. Home maintenance needs predicted lower SRH among older men and women living with others; uninhabitable conditions predicted poor SRH among older men living with others and older women living alone.

CONCLUSION

Results support the important effects of place in terms of home and community environments for older adults' SRH, and associations differed by gender and living arrangements.

A research framework for the United Nations Decade of Healthy Ageing (2021-2030)

The mission of UN Decade of Healthy Ageing (2020–2030) is to improve the lives of older people, their families and their communities. In this paper, we create a conceptual framework and research agenda for researchers to knowledge to address the Decade action items. The framework builds on the main components of healthy ageing: Environments (highlighting society and community) across life courses (of work and family) toward wellbeing (of individuals, family members and communities). Knowledge gaps are identified within each area as priority research actions. Within societal environments, interrogating beliefs about ageism and about familism are proposed as a way to illustrate how macro approaches to older people influence their experiences. We need to interrogate the extent to which communities are good places to grow old; and whether they have sufficient resources to be supportive to older residents. Further articulation of trajectories and turning points across the full span of work and of family life courses is proposed to better understand their diversities and the extent to which they lead to adequate financial and social resources in later life. Components of wellbeing are proposed to monitor improvement in the lives of older people, their families and communities. Researcher priorities can be informed by regional and national strategies reflecting Decade actions.

Factors Affecting Quality of Life among Older Adults with Hypertension in Urban and Rural Areas in Thailand: A Cross-Sectional Study

This study explored factors affecting quality of life in older adults with hypertension by comparing those living in urban and rural areas. A cross-sectional study was conducted on 420 older adults living in urban and rural areas in Thailand. Data were collected using the WHOQOL-OLD and Health-Promoting Lifestyle Profile-II tools, which measured quality of life and health-promoting behaviors among the participants. Older adults in urban areas had higher quality of life scores than those in rural locations. Health-promoting behaviors significantly predicted higher quality of life for all residents. A high perceived health status predicted increase of quality of life in urban residents, whereas the presence of comorbidity effects decreased quality of life. A longer hypertension duration predicted higher quality of life in rural residents. These findings suggest that healthy behaviors and self-management interventions are critical to improve quality of life in older Thai adults with hypertension.

Older people as active agents in their neighbourhood environments: Moving house can improve quality of life

BACKGROUND AND OBJECTIVES

Neighbourhood environments are an important aspect of well-being for older people. Developments of the general ecological model recognise older people as active agents who adapt their environments to fit their changing needs. We provide empirical support for a model suggested by Wahl et al., by examining interactions between neighbourhood environments, personal situations, relocation, and quality of life among older people.

RESEARCH DESIGN AND METHODS

Two statistical models were tested with a sample of community dwelling participants (aged 55-89) in the New Zealand Health, Work and Retirement longitudinal surveys conducted in 2016 (T1) and 2018 (T2). Multiple linear regression assessed the association of perceptions of housing and neighbourhood with quality of life (QoL) at T1 (n = 3682).

RESULTS

QoL was predicted by housing satisfaction, and neighbourhood satisfaction, accessibility, and trust (controlling for age, gender, marital status, home ownership, SES, physical health and mental health). Mixed ANOVA showed that those who moved house between T1-T2 reported lower housing and neighbourhood satisfaction than non-movers at T1. Over time T1-T2, movers reported less decline in housing satisfaction, and more positive change on all neighbourhood perceptions, with higher perceptions of neighbourhood accessibility than non-movers at T2.

DISCUSSION AND IMPLICATIONS

These findings support the theoretical model and provide impetus for more detailed study of the effects of the environment on well-being in older age. Housing and neighbourhood environments are a very practical focus for social policy change at local and national levels.

Neighbourhood Environment and Cognitive Vulnerability—A Survey Investigation of Variations Across the Lifespan and Urbanity Levels

Background: Understanding the impact of local communities on wellbeing is a paramount Sustainable Development Goal. In order to inform people-centred planning interventions, it is important to understand what demographic groups need supportive communities the most and where. This study explored associations between perceived neighbourhood characteristics and cognitive vulnerability, and the moderating role of age and urbanity of the place of residence. Methods: A convenience sample of 224 Irish adults completed a survey assessing cognitive vulnerability and perceptions of neighbourhood qualities, together with sociodemographic and residential information. Correlational analyses explored bivariate associations as well as moderating effects. A subsample (n = 142) provided qualitative accounts of their preferences of neighbourhood characteristics. Results: Regression analyses showed that controlling for sociodemographic factors, higher self-reported neighbourhood pleasantness was associated with lower cognitive vulnerability, particularly in older adults who lived in the most rural and urban areas (p = 0.006). Qualitative accounts suggested urban–rural variations in perceived accessibility and perceptual stressors, and age-related variations in social preferences. Conclusions: Our findings indicate a complex association between neighbourhood characteristics and cognitive wellbeing, highlighting the potential benefits of neighbourhood pleasantness for cognition particularly for older people in very rural or very urbanised places. Implications for research and environmental interventions are discussed.

Perceived Barriers to Rural Elderly Women's Health-Promoting Behaviors: An Ecological Perspective

This study multidimensionally examines rural elderly women's subjective barriers to practicing health-promoting behaviors. Twenty-six rural elderly women participated in three focus group interviews. Content analysis and a qualitative research method were used. The results, based on an ecological model, show that the implementation of health-promoting behaviors in rural elderly women was comprehensively related to intrapersonal (functional decline, passive attitude, and lack of implementation), interpersonal (lack of social support), community (restrictive conditions, accessibility issues, and lack of infrastructure), and public policy (lack of policy support) factors. Interventions addressing each factor can help reduce or eliminate the perceived barriers to health-promoting behaviors through interactions. Our findings can contribute to the development of health-promoting programs focused specifically on the socialization of rural elderly women and community-centered health policies in the future.

Social environment and quality of life among older people with diabetes and multiple chronic illnesses in New Zealand: Intermediary effects of psychosocial support and constraints

Purpose: In older people with diabetes, multimorbidity is highly prevalent and it can lead to poor quality of life. The overall purpose of this study was to examine the association between the social environment, psychosocial support and constraints, and overall quality of life among older people with and without with diabetes and multiple chronic illnesses.Methods: Self-reported data from participants in a cohort study of older New Zealanders was analysed. Responses from 380 older people diagnosed with diabetes and multiple chronic illnesses were compared with 527 older people with no health issues on indicators related to the associations of neighbourhood, health and ageing, using structural equation modelling.Results: The final model suggests that social provision, purpose in life and capabilities mediated between the social environment and quality of life, indicate that older people with positive social environment (i.e., neighbourhood advantage, residential stability) are much less likely to experience depression due to having good social support, meaningful life purpose and opportunities to engage.Conclusions: Perceived neighbourhood advantages, such as positive neighbourhood qualities, social cohesion and housing satisfaction, along with the focus on increasing social support, enhancing purpose in life and supporting one's capability to achieve, may serve as protective factors against depression.IMPLICATIONS FOR REHABILITATIONEnvironmental and personal circumstances can contribute to quality of life among older people with diabetes and multimorbidity.By providing older people with diabetes and multiple chronic illnesses a socially just environment that challenges ageism and other forms of oppression, this could reduce social disparities in health, improve inclusion and access to resources.Social and healthcare professionals are encouraged to design clinical care guidelines and rehabilitation goals from a wholistic and person/client centred approach to support older people with diabetes and multiple chronic illnesses.

Neighborhood environments and intrinsic capacity interact to affect the health-related quality of life of older people in New Zealand

OBJECTIVES

Following the WHO 2015 policy framework, we tested the effects of older people's intrinsic capacity and their perceptions of their neighborhood environments on mental and physical health-related quality of life (QoL) outcomes across two years.

STUDY DESIGN

Participants (mean age = 66) were drawn from two waves of a longitudinal study of aging (n = 2910) in 2016 and 2018. Regression analyses tested the main and interaction effects of intrinsic capacity and neighborhood factors on health-related QoL at T2 (controlling for T1).

MAIN OUTCOME MEASURES

Intrinsic capacity was assessed with number of chronic conditions. Neighborhood perceptions was assessed with measures of housing suitability, neighborhood satisfaction, and neighborhood social cohesion. Health-related QoL was assessed with SF12 physical and mental health component scores.

RESULTS

Perceptions of greater neighborhood accessibility and more trust among neighbours were associated with better mental health-related QoL two years later, but not to changes in physical health-related QoL. A significant interaction between intrinsic capacity and neighborhood access to facilities on physical health-related QoL over time showed that those reporting lower neighborhood access experienced a stronger impact of intrinsic capacity on physical health-related QoL.

CONCLUSIONS

The neighborhood environment is important to the wellbeing of older people and is amenable to policy interventions. We need more work on the aspects of the immediate environment that support QoL in older age. This study points to the need for accessible facilities and cohesive neighborhoods to support health.

Psychological, Social and Health-Related Challenges in Spanish Older Adults During the Lockdown of the COVID-19 First Wave

Background: The global pandemic of COVID-19 has required a population lockdown. Spain has one of the oldest/most aging populations in the world and was one of the most affected countries. We aim to describe the psychological and social implications as well as health-related behaviors as a result of the lockdown in community-dwelling older adults. Materials and Methods: Observational cross-sectional study. A total of 528 participants of over 60 years of age were recruited using snowball sampling technique during the lockdown of the COVID-19 first wave using an anonymous self-administered questionnaire composed of descriptive questions and validated scales for resilience (Brief Resilient Coping Scale) and emotions (Scale of Positive And Negative Experience). Results: Most participants (76.9%) live with other people and have an open space at home (64%). Only 33.7% continued doing activities to promote healthy aging, 65.7% did less physical activity and 25.6% increased their intellectual activity. Most of them (83%) used electronic communication with family and friends to a greater extent, and left the house to run basic errands. Greater scores on resilience showed significant negative correlations with age and negative feelings, and positive correlations with the size of the social network and positive feelings. Lacking an open space at home was associated with more negative feelings. Discussion: Older people are a vulnerable group severely affected by this pandemic crisis at multiple levels, requiring specific interventions to minimize the effects of changes in lifestyle that may be harmful. Detecting needs is essential to improve care and support from community health and social services, both nowadays and in future similar situations.

Beyond Housing: Perceptions of Indirect Displacement, Displacement Risk, and Aging Precarity as Challenges to Aging in Place in Gentrifying Cities

Neighborhoods within age-friendly cities and communities are an important factor in shaping the everyday lives of older adults. Yet, less is known about how neighborhoods experiencing change influence the ability to age in place. One type of rapid neighborhood change occurring across major cities nationally and globally is gentrification, a process whereby the culture of an existing neighborhood changes through the influx of more affluent residents and businesses. Few studies have considered the impact of gentrification on older adults, who are among the most vulnerable to economic and social pressures that often accompany gentrification. The current study explores one consequence of gentrification, indirect displacement. While gentrification-induced displacement can refer to the physical (e.g., direct) displacement of residents moving out of a neighborhood due to rising housing costs, it also references the replacement of the unique character and social identity of a neighborhood (e.g., indirect displacement). We examine perceptions of the latter, characterized by perceived cultural shifts and housing concerns among adults aging in place in a gentrifying neighborhood in New York City. The implications of indirect displacement for displacement risk and aging precarity are discussed as potential threats to aging in place in age-friendly cities.

Neighborhood Experiences of People Over Age 50: Factor Structure and Validity of a Scale

Background and Objectives

Various aspects of the neighborhood environment have been shown to correlate with older adults’ health. Socio-ecological models of health posit that interventions in the living environment can influence population health. Yet, there are no scales to comprehensively measure older people’s experiences of their neighborhoods especially in dense urban contexts. This study analyzes the psychometric properties and factor structure of a holistic measure of Older People’s Neighborhood Experience (OpenX) to understand constituent factors of residential satisfaction and well-being in dense urban contexts.

Research Design and Methods

Participants were 1,011 community-dwelling older adults aged 50 and older in Singapore. Face-to-face interviews were conducted. Questions were drawn to measure physical and social aspects of the neighborhood as well as sociodemographic variables. Exploratory and confirmatory factor analyses were conducted to obtain a shorter version; content validity, internal consistency, and external validity were assessed.

Results

The OpenX has a 4-dimensional structure, explaining 45.5% of the variance of neighborhood experience. They are communal affordance, embeddedness, environment pleasantness, and time outdoors. Good reliability and validity were found, including Cronbach’s alpha of 0.827. The correlation between neighborhood experience and objectively measured proximity to parks and fitness corners approached significance (p = .082).

Discussion and Implications

The 16-item OpenX demonstrated good psychometric properties. With reference to the transdisciplinary neighborhood health framework, it is useful for assessing older adults’ neighborhood environment, identifying neighborhoods for pilot population health interventions, and understanding how the neighborhood environment affects older adults’ health.