Is a healthy city also an age-friendly city?

Leveraging Higher Education in Our Age-Friendly World

There is increasing interest in better understanding the connection between higher education and age-friendly community efforts. The global age-friendly community (AFC) movement calls for multi-sectoral engagement in a multi-year model encompassing four core phases (engage, plan, act, measure) to improve livability in domains of community life pertaining to the built, social, and service environment. However, there is limited empirical knowledge regarding the involvement of higher education and how it supports AFC efforts. We used qualitative inquiry to assess the engagement of U.S. institutions as reported by 80 AFCs that completed a five-year cycle of participation. We conducted directed content analysis using paired AFC action plans and progress reports (n = 56) and classified engagement using a priori indicators by higher educational core activities (teaching, research, and service), core phases (e.g. measure), and clustered domain areas (e.g. built environment). Results reveal engagement across all core activities of higher education with most efforts in research, in all areas of the AFC model with most reported in the action phase, and across all clustered domains of practice with the greatest amount identified in the social environment. We identify opportunities for greater engagement and leadership through higher education in our age-friendly world.

Community Environment Co-Production and Environmental Satisfaction of Older Urban Residents in Shanghai, China

OBJECTIVE

Many factors may affect the environmental satisfaction of elderly people, including their sense of involvement. This study examined the associations between community environment co-production and environmental satisfaction in older urban residents in China.

METHODS

A cross-sectional survey was conducted in four age-friendly communities in Shanghai, China. Co-production and environmental satisfaction were assessed through a self-developed questionnaire. General health status was measured through the EuroQol-Visual Analogue Scale (EQ-VAS). Data on affective commitment for the community demographic and health-related factors were also collected. Multilevel linear regression was used to detect the associations.

RESULTS

In total, 480 older urban residents completed the survey. On average, the environment satisfaction score was 76.82/90, 8/10 for co-production, and 87.5/100 for EQ-VAS. Univariate analysis demonstrated environmental satisfaction was associated with educational background, party membership, physical activity, community location, age, sleep hours, co-production, affective commitment, and EQ-VAS. After controlling for confounding factors, the co-production score was significantly associated with higher environmental satisfaction (β = 4.68, p < 0.001). Multiple linear regression revealed that effective commitment for the community (β = 6.17, p < 0.001) and EQ-VAS (β = 0.06, p = 0.002) were also significantly associated with environment satisfaction.

CONCLUSION

Community environment co-production was positively associated with environmental satisfaction among older urban residents in Shanghai. Environmental co-production should be encouraged when developing age-friendly communities for the elderly.

Active and healthy ageing in urban environments: laying the groundwork for solution-building through citizen science

Urban age-friendly initiatives strive to promote active and healthy ageing by addressing urban influences that impact individuals as they age. Collaborative community partnerships with multi-level stakeholders are crucial for fostering age-friendly initiatives that can transform urban community health. Employing a citizen social science (CSS) approach, this study aimed to engage older adults and stakeholders in Birmingham, UK, to (i) identify key urban barriers and facilitators to active and healthy ageing, and (ii) facilitate collaboration and knowledge production to lay the groundwork for a citizen science project. Older adults (n = 16; mean age = 72(7.5 SD); 11 female) and community stakeholders (n = 11; 7 female) were engaged in six online group discussions, with audio recordings transcribed and thematically analysed to present key urban barrier and facilitator themes. Ageism, winter, technology and safety were barriers identified by both groups. Outdoor spaces and infrastructure, transportation, community facilities, and Covid-19 pandemic were identified as barriers and/or facilitators. Older adults identified the ageing process as a barrier and diversity of the city, health and mobility and technology as facilitators. For stakeholders, barriers were deprivation and poverty, gender differences, and ethnicity, whereas age-inclusive activities were a facilitator. Organic and active opportunities for older adults and stakeholders to connect, co-produce knowledge on urban environments and share resources presented foundations of solution-building and future collaboration. CSS effectively facilitated a range of stakeholders across local urban spaces to collaborate and co-produce ideas and solutions for enhancing local urban environments to promote active and healthy ageing.

Using systems thinking to assess the functioning of an "Age-Friendly City" governance network in Australia

Age-Friendly Cities (AFC) is a framework for promoting healthy ageing through local actions. We use systems thinking to assess potential outcomes of actions to support older people's mobility, undertaken within an AFC commitment in Greater Sydney. Interviews with 20 informants involved in providing space, infrastructure, or services that affect how older people get around were analysed using causal loop diagrams (CLDs). Four approaches to support older people's mobility were identified and situated to the Multiple Governance Framework: land use, open and public space, supplementary transport, and community transport. Analysis revealed potential for unwanted consequences associated with each, which can be generalised into three generic potential outcomes for other jurisdictions to consider. A recommendation from this research is for policy actors to examine feedback interactions between actions so that they can foresee a wider range of outcomes and take defensive action against those unwanted. By situating CLDs within the Multiple Governance Framework, this research not only identifies what to look for, in terms of potential outcomes, but also where to look, in terms of the level of decision-making. This research offers a new way to assess the functioning of AFC governance networks by their collective outcomes and challenges the standards for the evaluation of AFC.

Age-friendly environments and depressive symptoms among Korean adults: The mediating effects of loneliness

OBJECTIVES

In this study, we examined (1) group differences with regard to age-friendly environments (AFE), loneliness, and depressive symptoms among younger, middle-aged, and older Korean adults; (2) the relationship of AFE to loneliness and depressive symptoms; and (3) the mediating effect of loneliness on the relationship between AFE and depressive symptoms among three Korean adult groups.

METHOD

We used a cross-sectional survey design featuring multistage quota sampling. Study participants were 1,017 Korean adults aged 18 years or older. Multi-group structural equation modeling was used for data analysis.

RESULTS

Statistically significant age group differences were found in the mean values of loneliness and depressive symptoms, but no significant age group differences in the mean values of AFE were observed. Older adults showed a significant relationship between AFE and loneliness, while their younger counterparts demonstrated a significant relationship between AFE and depressive symptoms. The mediating effect of loneliness on the association between AFE and depressive symptoms was found only for the older age group.

CONCLUSION

The results of the study contribute to the existing understanding of AFE and mental health among Korean adults, while providing service providers and policy makers with fundamental background information on alleviating depression.

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.

A Commentary on Blue Zones®: A Critical Review of Age-Friendly Environments in the 21st Century and Beyond

This paper explores the intersection of the World Health Organization’s (WHO) concepts of age-friendly communities and The Blue Zones^® checklists and how the potential of integrating the two frameworks for the development of a contemporary framework can address the current gaps in the literature as well as consider the inclusion of technology and environmental press. The commentary presented here sets out initial thoughts and explorations that have the potential to impact societies on a global scale and provides recommendations for a roadmap to consider new ways to think about the impact of health and wellbeing of older adults and their families. Additionally, this paper highlights both the strengths and the weaknesses of the aforementioned checklists and frameworks by examining the literature including the WHO age-friendly framework, the smart age-friendly ecosystem (SAfE) framework and the Blue Zones^® checklists. We argue that gaps exist in the current literature and take a critical approach as a way to be inclusive of technology and the environments in which older adults live. This commentary contributes to the fields of gerontology, gerontechnology, anthropology, and geography, because we are proposing a roadmap which sets out the need for future work which requires multi- and interdisciplinary research to be conducted for the respective checklists to evolve.

How Can the Lived Environment Support Healthy Ageing? A Spatial Indicators Framework for the Assessment of Age-Friendly Communities

The Age-Friendly Cities and Communities Guide was released by the World Health Organization over a decade ago with the aim of creating environments that support healthy ageing. The comprehensive framework includes the domains of outdoor spaces and buildings, transportation, housing, social participation, respect and inclusion, civic participation and employment, communication and information, and community and health services. A major critique of the age-friendly community movement has argued for a more clearly defined scope of actions, the need to measure or quantify results and increase the connections to policy and funding levers. This paper provides a quantifiable spatial indicators framework to assess local lived environments according to each Age-Friendly Cities and Communities (AFC) domain. The selection of these AFC spatial indicators can be applied within local neighbourhoods, census tracts, suburbs, municipalities, or cities with minimal resource requirements other than applied spatial analysis, which addresses past critiques of the Age-Friendly Community movement. The framework has great potential for applications within local, national, and international policy and planning contexts in the future.

Moving Toward a Global Age-Friendly Ecosystem

The designation of "age friendly" has clearly engaged the attention of scholars and leading experts in the field of aging. A search of PubMed references citing the term produced 15 results in the 5-year period from 2006 to 2011; that number increased to 572 in the period from 2015 to 2019. The work, notably led by the World Health Organization with the initiation of age-friendly cities and age-friendly communities, has now sparked a movement for the creation of age-friendly health systems and age-friendly public health systems. Now more than ever, in an era of pandemics, it seems wise to create an ecosystem where each of the age-friendly initiatives can create synergies and additional momentum as the population continues to age. Work of a global nature is especially important given the array of international programs and scientific groups focused on improving the lives of older adults along with their care and support system and our interconnectedness as a world community. In this article, we review the historical evolution of age-friendly programs and describe a vision for an age-friendly ecosystem that can encompass the lived environment, social determinants of health, the healthcare system, and our prevention-focused public health system.

Urban Ageing in Europe—Spatiotemporal Analysis of Determinants

The aim of this study was to identify determinants of the population ageing process in 270 European cities. We analyzed the proportion of older people: men and women separately (aged 65 or above) in city populations in the years 1990–2018. To understand territorially-varied relationships and to increase the explained variability of phenomena, an explanatory spatial data analysis (ESDA) and geographically weighted regression (GWR) were applied. We used ArcGIS and GeoDa software in this study. In our research, we also took into account the spatial interactions as well as the structure of cities by size and level of economic development. Results of the analysis helped to explain why some urban areas are ageing faster than others. An initial data analysis indicated that the proportion of the elderly in the population was spatially diversified and dependent on gender, as well as the size and economic development of a unit. In general, elderly individuals were more willing to live in larger and highly developed cities; however, women tended to live in large areas and men in medium-sized to large urban areas. Then, we conducted the urban ageing modelling for men and women separately. The application of GWR models enabled not only the specification of the city population ageing determinants, but also the analysis of the variability in the strength and direction of dependencies occurring between the examined variables in individual cities. Significant differences were noted in the analysis results for specific cities, which were often grouped due to similar parameter values, forming clusters that divided Europe into the eastern and western parts. Moreover, substantial differences in results were obtained for women and men.

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

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

Urban-Rural Differences in Older Adult Depression: A Systematic Review and Meta-analysis of Comparative Studies

CONTEXT

Depression among older adults (aged 60 years or older) is a problem that could be exacerbated by global trends in urbanization and population aging. The study purpose was to assess whether urban, relative to rural, residence is associated with depression among older adults and whether associations differ in countries with developed versus developing economies.

EVIDENCE ACQUISITION

In 2017, the authors identified and extracted information from comparative studies of urban-rural depression prevalence among older adults. Studies were identified in PubMed, PsychINFO, and Web of Science and limited to English language articles published after 1985. Eighteen studies met inclusion criteria. Random effects meta-analysis was conducted to produce weighted pooled ORs estimating the association between urban-rural residence and depression for all study participants (N=31,598) and sub-analyses were conducted for developed (n=12,728) and developing (n=18,870) countries.

EVIDENCE SYNTHESIS

Depression prevalence was significantly higher among urban residents in ten studies and significantly higher among rural residents in three studies (all three conducted in China). Associations between urban-rural residence and depression generally remained significant after adjusting for covariates. In developed countries, the odds of depression were significantly higher among urban than rural residents (pooled OR=1.44, 95% CI=1.10, 1.88). However, in developing countries, this association was not observed (pooled OR=0.91, 95% CI=0.46, 1.77).

CONCLUSIONS

Converging trends of urbanization and population aging could increase the global burden of depression among older adults. The pathways through which urban-rural residence influences depression risk among older adults might differ by country context. Future research should focus on measuring variation in these contexts.

Examining Stakeholder Perspectives: Process, Performance and Progress of the Age-Friendly Taiwan Program

Since Taiwan's age-friendly city (AFC) program was launched in 2012, the central government has provided various resources to the country's 22 local authorities, including budgetary support, policy advocacy, and consultation from a team of experts. This study examines stakeholder perspectives on the process, performance, and outcome of the AFC program. A 53-item questionnaire was developed based on the World Health Organization (WHO) guideline, including mechanisms and processes (20 items), outcome evaluations (23 items), and resource integration (10 items). There was a "great difference" found among scores between facilitators and experts for "inter-exchange experience with local and international cities" (40%) and "monitor and revise indicators" (37%) in mechanisms and processes, "evaluate performance of indicators and action plans" (37%) in outcome evaluations, and "interaction between government and community" (46%) and "interaction between civil organization and senior society" (39%) in resource integration. Clearly, facilitators showed overly optimistic assessments in AFC mechanisms and processes, outcome evaluation, and resource integration. The results showed disconnect between experts' expectations versus actual practice conducted by facilitators. Implications of these findings are to integrate top down expectations with the realities of bottom up practice to design more realistic evaluations; continue to educate stakeholders about design, implementation and evaluation; and further integrate resources from government, civil organizations, and community.

Developing indicators for evaluation of age-friendly communities in Canada: process and results

INTRODUCTION

In 2006, the World Health Organization launched the Global Age-Friendly Cities Project to support active aging. Canada has a large number of age-friendly initiatives; however, little is known about the effectiveness and outcomes of age-friendly community (AFC) initiatives. In addition, stakeholders report that they lack the capacity and tools to develop and conduct evaluations of their AFC initiatives. In order to address these gaps, the Public Health Agency of Canada developed indicators to support the evaluation of AFC initiatives relevant to a wide range of Canadian communities. These indicators meet the varied needs of communities, but are not designed to evaluate collective impact or enable crosscommunity comparisons.

METHODS

An evidence-based, iterative consultation approach was used to develop indicators for AFCs. This involved a literature review and an environmental scan. Two rounds of key expert and stakeholder consultations were conducted to rate potential indicators according to their importance, actionability and feasibility. A final list of indicators and potential measures were developed based on results from these consultations, as well as key policy considerations.

RESULTS

Thirty-nine indicators emerged across eight AFC domains plus four indicators related to long-term health and social outcomes. All meet the intended purpose of evaluating AFC initiatives at the community level. A user-friendly guide is available to support and share this work.

CONCLUSION

The AFC indicators can help communities evaluate age-friendly initiatives, which is the final step in completing a cycle of the Pan-Canadian AFC milestones. Communities are encouraged to use the evaluation results to improve their AFC initiatives, thereby benefiting a broad range of Canadians.