Modelling age-friendly environment for social connectedness: a cross-sectional study

Background: The increase in aged populations in Malaysia has brought unprecedented challenges to families, policy makers, scholars, and business organisations.  This paper adapted the WHO 2007 framework of features of age-friendly cities to examine age-friendly environment constructs and their linkages with social connectedness from the perspective of Malaysian middle-aged and older adults caring for themselves.

Methods: A face-to-face cross-sectional survey was conducted on 402 middle-aged and older adults caring for themselves across selected states in west Malaysia, selected via purposive sampling. Firstly, features of age-friendly cities were explored through exploratory factor analysis involving 82 respondents. Subsequently, structural equation modelling was performed, involving 320 respondents.

Results: The results indicated that the constructs of an age-friendly environment were built environment, community support and health services, civic participation, and employment as well as communication and information. The structural model provided evidence that implementing age-friendly initiatives relating to built environment, community support and health services, civic participation and employment as well as communication and information enables the ageing population to improve their connectedness with society. These findings supported the ecological theories, agreeing that age-friendly environments help middle-aged and older adults caring for themselves to increase their adaptability and reduce perceived pressure from the environment. This result was in line with the current literature in which an age-friendly environment is a form of support and an enabling environment to cultivate positive social relationships and connectivity.

Conclusions: Creating an age-friendly environment that supports active and healthy living for middle-aged and older adults caring for themselves allows them to continue to share their experiences, knowledge, and wisdom. This is helpful and beneficial for societal well-being and economic development as well as for the future generations.

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.

Age-Friendly Features in Home and Community and the Self-Reported Health and Functional Limitation of Older Adults: the Role of Supportive Environments

This study aims to identify age-friendly community features that are associated with better health for older adults. This cross-sectional study utilized the 2015 AARP Age-Friendly Communities (AFC) Survey, which includes 66 home and community features that fall within the eight domains specified by the World Health Organization (WHO)'s age-friendly cities guidelines. Two measures of health (self-rated health and functional limitations) were examined using multi-level linear and logistic regressions. Both a greater perceived availability of age-friendly features in communities and a good person-environment fit were associated with better self-rated health and a lower likelihood of reporting functional limitations. The domains of outdoor spaces and buildings, transportation, and social participation and inclusion were consistently associated with these outcomes. Promoting age-friendliness in outdoor spaces and buildings, transportation, and social participation and inclusion domains by providing green spaces, neighborhood safety programs, transportation options, and social opportunities may be the most effective way to support healthy and active aging.

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

BACKGROUND AND OBJECTIVES

The WHO "Framework for Policy for Healthy Ageing' (2015) focuses on the broader environment and the support it provides for everyday functioning of older people. The concept of "livability" supports this framework by providing a conceptualization of environments that support good quality of life.

RESEARCH DESIGN AND METHODS

This observational study used an ecological framework of livability to assess cross-sectional relationships between living environments and perceived quality of life among 4,028 respondents, aged 50-89 years who were surveyed in 2016. A 4-step hierarchical model regressed quality of life on individual resources (health, chronic conditions, SES), contextual variables (distance to health care; rural/urban setting), perceptions of housing and neighborhood environments (housing satisfaction, neighborhood quality, neighborhood social cohesion), and interactions between these levels of the ecological model.

RESULTS

As predicted, housing and neighborhood perceptions contributed an additional 5% variance to the model which explained 49% of quality of life. There were significant interactions between the contextual variables and qualities of housing and neighborhood.

DISCUSSION AND IMPLICATIONS

These findings support the importance of material and social provisions of housing and neighborhoods to quality of life among older people. The ecological model highlights critical information provided by taking different levels of the environment and personal circumstances into account. The concept of "livability," focusing on perceptions of the environment, can assist a shift from seeking the universal ideal neighborhood toward understanding the ways in which different communities may achieve quality of housing and neighborhood facilities that meet community members' needs.

Perspectives on Active Transportation in a Mid-Sized Age-Friendly City: "You Stay Home"

Background: Active transportation is an affordable and accessible form of transportation that facilitates the mobility of older adults in their communities. Age-friendly cities encourage and support physical activity and social participation among older adults; however, they often do not adequately address active transportation. Our goal was to identify and understand the constraints to active transportation that older adults experience in order to inform the development of viable solutions. Methods: Focus group interviews were conducted with community dwelling older adults (n = 52) living in the City of Oshawa in Ontario, Canada; each focus group targeted a specific demographic to ensure a diverse range of perspectives were represented. Data were analyzed to identify themes; sub-group analyses were conducted to understand the experience of those from low socioeconomic status and culturally diverse groups. Results: Themes pertaining to environmental, individual, and task constraints, as well as their interactions, were identified. Of particular novelty, seemingly non-modifiable constraints (e.g., weather and personal health) interacted with modifiable constraints (e.g., urban design). Culturally diverse and lower socioeconomic groups had more favorable perspectives of their neighborhoods. Conclusion: While constraints to active transportation interact to exacerbate one another, there is an opportunity to minimize or remove constraints by implementing age-friendly policies and practices.

A Capabilities Approach to Unequal Trajectories of Healthy Aging: The Importance of the Environment

Objectives: We aimed to examine the relationships of older people’s standard of living and perceived quality of housing and neighborhoods, with different physical, mental, and social well-being trajectories over time. Method: Longitudinal data from 2,483 New Zealanders (55-70 years of age in 2006) surveyed biennially for 10 years were analyzed using latent profile growth analysis and MANOVA. Results: Five health trajectories were revealed: robust health, average good health, declining physical health, limitations in mental health and social well-being, or vulnerable health. Trajectory group membership was significantly related to economic standard of living, satisfaction with housing, quality of neighborhood, and social cohesion of neighborhood. Discussion: The findings support a focus on environmental resources to explain inequalities in health. Future research could focus on developing the basis of these associations. Policies to offset such inequalities would focus on social and physical environmental support for the maintenance of social, mental, and physical health in older age.

Modeling Age-Friendly Environment, Active Aging, and Social Connectedness in an Emerging Asian Economy

This paper empirically tested eight key features of WHO guidelines to age-friendly community by surveying 211 informal caregivers and 402 self-care adults (aged 45 to 85 and above) in Malaysia. We examined the associations of these eight features with active aging and social connectedness through exploratory and confirmatory factor analyses. A structural model with satisfactory goodness-of-fit indices (CMIN/df = 1.11, RMSEA = 0.02, NFI = 0.97, TLI = 1.00, CFI = 1.00, and GFI = 0.96) indicates that transportation and housing, community support and health services, and outdoor spaces and buildings are statistically significant in creating an age-friendly environment. We found a statistically significant positive relationship between an age-friendly environment and active aging. This relationship is mediated by social connectedness. The results indicate that built environments such as accessible public transportations and housing, affordable and accessible healthcare services, and elderly friendly outdoor spaces and buildings have to be put into place before social environment in building an age-friendly environment. Otherwise, the structural barriers would hinder social interactions for the aged. The removal of the environmental barriers and improved public transportation services provide short-term solutions to meet the varied and growing needs of the older population.