Exploring configurations of social determinants for enhancing older adult health in China: an fuzzy-set qualitative comparative analysis based on 31 provinces in China

With China's aging population on the rise, addressing population aging has become a national priority, particularly focusing on improving older adult health. This study employs the social determinants of health framework, considering China's unique macro-social, economic, policy, healthcare, and family cultural factors, to develop a framework for understanding the social determinants of health for older adult in China. Using the fsQCA method and a configurational perspective, the complex relationship between social determinants of health and older adult health status is examined. The findings indicate that individual social determinants alone are insufficient for achieving high levels of older adult health. Instead, three configurations of social determinants have been identified as conducive to high older adult health: Economic Development-Environment - Cultural Dominant Type, Socio-Economic Development - Older Adult Security - Environment - Cultural Dominant Type, and Economic Development Dominant Type. These configurations offer diverse pathways for enhancing older adult health. Conversely, the study identifies two configurations associated with low older adult health levels, exhibiting an asymmetric relationship with the configurations resulting in high older adult health levels. Moreover, economic development consistently emerges as a core condition across all three configurations associated with high older adult health levels, while two configurations associated with low older adult health lack this core condition. These findings underscore the universal contribution of enhancing economic development to improving older adult health.

Awareness and Perceptions of "Age-Friendly": Analyzing Survey Results from Voices in the United States

The term "age-friendly" is widely used to describe cities, communities, health systems, and other environments. However, little is known about how this is interpreted or what the term means to the public. To investigate the public's familiarity with the term and gain insights into its relevance to older adults, we utilized data generated by a survey of 1000+ adults aged 40 and above. We employed a 10-question survey, distributed online in the US from 8 to 17 March 2023 via a third-party vendor, that captured awareness and perceptions of age-friendly designations by exploring awareness of the term, contextual understanding, and influence on decision making. The resultant aggregate data was analyzed using Microsoft Excel and straightforward summary statistical analyses. The majority of respondents (81%) were aware of the term "age-friendly." Older adults (ages 65+) lagged in the self-described extreme or moderate level of awareness compared to adults aged 40-64. In the surveyed population, the term "age-friendly" was most often understood to apply to communities (57%), followed by health systems (41%) and cities (25%). Most people believed "age-friendly" refers to all ages, even though age-friendly health systems are designed to meet the unique needs of older adults. These survey results provide the age-friendly ecosystem field with insights into the awareness and perceptions of the term "age-friendly," highlighting opportunities to bolster understanding.

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.

Influence of promoting an "age-friendly cities" strategy on psychological capital and social engagement based on the scenario method

Holding large conferences and events usually encourages the corresponding government to upgrade the host city. For this process, incorporating additional costs to increase accessibility for the elderly is a feasible means for a city to develop in an age-friendly manner. Providing evidence-based reports to policy makers is conducive to implementing the policies of age-friendly cities. This study used the scenario method to simulate the effect of promoting the "age-friendly cities" strategy on residents' psychological capital and social engagement (SE). We found that promoting the construction of age-friendly cities can significantly improve residents' psychological capital and SE and that residents from all age groups can benefit. This paper provides an economical means to influence policymakers through evidence-based reports in promoting the development of age-friendly cities.

Age-Friendly Communities and Older Adults’ Health in the United States

As age-friendly community (AFC) initiatives grow, it will be essential to determine whether older adults who live in an AFC have better health than those who live in other environments. This study uses data from the 2017 AARP AFC Surveys and the AARP Livability Index to assess whether AFCs promote the health of older adults. We analyze data for 3027 adults aged 65 and older who reside in 262 zip code areas. Following AARP guidelines, we allocated the sample into two groups: an AFC group (livability score of 51+; n = 2364) and a non-AFC (score ≤ 50, n = 663). The outcome variable was self-rated health (M = 3.5; SD = 1.1; range: 1–5). We used an inverse probability weighting approach to evaluate whether older adults who live in an AFC reported better self-rated health than those who live in a non-AFC. Findings showed that older adults who lived in an AFC had better self-rated health than those in a non-AFC (b = 0.08, p = 0.027). Compared to non-Hispanic Whites, Black and Hispanic older adults reported worse self-rated health. Inasmuch as living in an AFC can promote the well-being of older adults, policymakers and practitioners should continue to develop and sustain high-quality, accessible built and social environments.

The influence mechanism of community-built environment on the health of older adults: from the perspective of low-income groups

Background

With the rapid development of population ageing, the international community has been paying more attention to the health problems of older adults and the age-friendly community. But there has not been enough discussion about the internal mechanism of the community-built environment that influences the health of older adults. The aim of our study was to explore the complex relationships among community-built environment, social participation, outdoor exercise, and health of older adults, as well as the differences among older adults in different income groups, particular attention was paid to the situation of low-income group.

Methods

This study used descriptive statistical analysis and structural equation Modeling (SEM) to make a group comparison among older adults in different income groups. The data of this study came from a sample survey in Shanghai, China.

Results

The study found that health difference exists among older adults in China: the lower the income, the worse the community-built environment, the worse the health. The community-built environment had an important impact on the health of older adults, especially the low-income older adults. And the community-built environment influenced the health of older adults through the intermediary role of outdoor exercise and social participation. Furthermore, the lower the income level of older adults, the stronger the direct effect of the community-built environment on their health; the higher the income level of older adults, the stronger the mediating effect of outdoor exercise and social participation on the impact of the community-built environment on their health.

Conclusion

Governments should pay more attention to the health and living conditions of low-income older adults and take proactive steps to help them. Community design and construction should pay more attention to the demands of low-income older adult groups, which will help to improve the health inequality of older adults, consequently enhancing older adults’ overall health.

Environmental barriers matter from the early stages of functional decline among older adults in France

Background

The adaptation of living environments can preserve functional independence among older people. A few studies have suggested that this would only benefit the most impaired. But conceptual models theorize that environmental pressure gradually increases with functional decline.

Objectives

We examined (1) how far different environmental barriers increased difficulties and favoured resort to assistance; (2) at what stage in functional decline environmental barriers begin to matter.

Methods

We used the French cross-sectional survey CARE (2015), including 7,451 participants (60+) with at least one severe functional limitation (FL). Multinomial logistic regressions models were used to compare predicted probabilities for outdoor activities of daily living (OADL) difficulties (no OADL difficulties; difficulties but without assistance; use of assistance) among individuals with and without environmental barriers (self-reported or objective), in relation to the number of FLs.

Results

Poor-quality pedestrian areas and lack of places to rest were associated with a higher probability of experiencing OADL difficulties, whatever the number of FLs; the association increased with the number of FLs. Up to 6 FLs, individuals with these barriers were more likely to report difficulties without resorting to assistance, with a decreasing association. Living in cities/towns with high diversity of food outlets was associated with a lower probability of reporting assistance, whatever the number of FLs, but with a decreasing association.

Discussion

Overall, the results suggest that environmental barriers increasingly contribute to OADL difficulties with the number of FLs. Conclusions differed as to whether they tended to favour resort to assistance, but there was a clear association with food outlets, which decreased with impairment severity. The adaptation of living environments could reduce difficulties in performing activities from the early stages of decline to the most severe impairment. However, the most deteriorated functional impairments seem to generate resort to assistance whatever the quality of the environment.

The Effects of Urban Neighborhood Environmental Evaluation and Health Service Facilities on Residents' Self-Rated Physical and Mental Health: A Comparative and Empirical Survey

(1) Background: The neighborhood environment has been shown to be an essential factor affecting residents’ quality of life and health, but the relationship between the characteristics of health service facilities and health levels is rarely known. (2) Methods: This study used a representative sample (n = 591, 303 women; 288 men, age 18–85 years, lived in Chengdu for an extensive time) of residents living in Chengdu City, China, and took spatial point data and empirical research data to construct an ordered logistic regression model. We contrastively analyzed the influence of different variables in the neighborhood environment and health service facilities on self-rated physical health (SRPH) and self-rated mental health (SRMH). (3) Results: The frequency of use and accessibility of multiple facilities in the health service facilities were significantly associated with self-rated health (SRH). Significant differences occurred between residents’ perceived accessibility and actual accessibility of facilities in SRH. Comparing the results of SRPH and SRMH revealed that the influencing factors that affect the two vary. The factors that significantly affect SRMH include neighborhood physical environment evaluation; social environmental evaluation; the frequency of use of the parks and squares, and sports zones; and the accessibility of parks and squares, specialized hospitals, community hospitals, and pharmacies. However, the factors that significantly affect SRPH include the frequency of use of sports venues, general hospitals, and pharmacies and the accessibility of general hospitals. The social environment of the neighborhood is also a non-negligible part, and its interaction with the physical environment of the neighborhood affects the outcome of SRH. (4) Conclusions: Neighborhood environmental characteristics and the layout of health service facilities have significant differential effects on people’s physical and psychological health, and this information is of great value in promoting healthy city development and improving the quality of life of urban populations around the world.

Perceived Community Age-friendliness is Associated With Quality of Life Among Older Adults

We examined the positive association between perceived community age-friendliness and self-reported quality of life for older adults. A total of 171 participants, aged 77–96 years, completed a mail-in questionnaire package that included measures of health (SF-36 Physical), social participation (Social Participation Scale), community age-friendliness (Age-Friendly Survey [AFS]), and quality of life (WHO Quality of Life). Hierarchical regression models including age, gender, driving status, finances, health, social participation, and AFS scores explained 8 to 21 per cent of the variance in quality of life scores. Community age-friendliness was a statistically significant variable in all models, accounting for three to six and a half per cent of additional variance in quality of life scores. Although the proportion of variance explained by age-friendliness was small, our findings suggest that it is worthwhile to further investigate whether focused, age-friendly policies, interventions, and communities could play a role towards successful and healthy aging.

Digitalization in Food Supply Chains: A Bibliometric Review and Key-Route Main Path Analysis

Technological advances such as blockchain, artificial intelligence, big data, social media, and geographic information systems represent a building block of the digital transformation that supports the resilience of the food supply chain (FSC) and increases its efficiency. This paper reviews the literature surrounding digitalization in FSCs. A bibliometric and key-route main path analysis was carried out to objectively and analytically uncover the knowledge development in digitalization within the context of sustainable FSCs. The research began with the selection of 2140 articles published over nearly five decades. Then, the articles were examined according to several bibliometric metrics such as year of publication, countries, institutions, sources, authors, and keywords frequency. A keyword co-occurrence network was generated to cluster the relevant literature. Findings of the review and bibliometric analysis indicate that research at the intersection of technology and the FSC has gained substantial interest from scholars. On the basis of keyword co-occurrence network, the literature is focused on the role of information communication technology for agriculture and food security, food waste and circular economy, and the merge of the Internet of Things and blockchain in the FSC. The analysis of the key-route main path uncovers three critical periods marking the development of technology-enabled FSCs. The study offers scholars a better understanding of digitalization within the agri-food industry and the current knowledge gaps for future research. Practitioners may find the review useful to remain ahead of the latest discussions of technology-enabled FSCs. To the authors’ best knowledge, the current study is one of the few endeavors to explore technology-enabled FSCs using a comprehensive sample of journal articles published during the past five decades.

Perceptions of community among suburban and urban-dwelling adults aging in place

Community is important for late-midlife adults, offering a sense of belonging and opportunities for social engagement during the transition to older age. The current study examines perceptions of community and geographical ties among a sample of older adults aging in place. Using data from the Foley Longitudinal Study of Adulthood (FLSA; N = 163; aged 61-64) and a qualitative GIS approach, major themes were categorized and mapped to create a comprehensive picture of how perceptions of community varied among respondents and neighborhoods. Core themes were connections to place, space, people, and relational benefits gained from community involvement. Residents of a suburban enclave more frequently noted connections to people as being important to community, compared to residents in more densely-populated areas. Implications for future research are discussed.

Effect of income inequality, community infrastructure and individual stressors on adult depression

This paper considers the impact of variables at three different levels-city, community and individual-on the depression of adults aged 45 years and above in China. Evidence shows that community factors, such as infrastructure and elderly centres, are critical to reduce depression but the effect of city-level factors such as lowering income inequality and improving public health investment is different for the segments of poor and non-poor as well as the rural and urban residents. This highlights the need to consider targeted policy mix options to avoid resource misallocation. Lastly, Chinese females' depression has worsened over time with ageing, particularly those who drink alcohol or are less educated are prone to depression prompting the need for specialist women health centres.

Fidelity and utility of GPS loggers as a tool for understanding community participation of older adults

OBJECTIVE

The purpose of this research was to examine the fidelity and utility of global positioning system (GPS) technology for studying community mobility indicators, and to explore implications for community participation for older adults.

METHOD

A longitudinal cohort design with community-dwelling older adults (n = 33) was employed. GPS spatial data and activity logs were collected at baseline and one year later. Data were analysed to evaluate the fidelity of the GPS protocol, the nature and frequency of destinations, and the stability of community mobility over time.

RESULTS

Findings include evidence for high reliability of the GPS loggers to record out-of-home trips when compared to activity logs; utility of the technology for identifying frequency and type of occupational destinations; and the relative stability of two community mobility variables over time. GPS loggers generate key insights into how older adults move in and through their community as they engage in a range of occupations.

CONCLUSION

GPS technology is a robust and useful tool for gathering novel information, especially when combined with qualitative data. GPS loggers may be incorporated in evaluation or to tailor interventions. Community mobility enables social participation, and warrants further research using these methods to support processes of aging in place.

Longitudinal associations between neighbourhood physical environments and depressive symptoms of older adults in Hong Kong: The moderating effects of terrain slope and declining functional abilities

Little is known about the accumulative impacts of neighbourhood physical environments on older adults' depressive symptoms over time. Based on a cohort study of 2081 older adults in Hong Kong, this study examined longitudinal relationships between neighbourhood physical environments and depressive symptoms among older adults, with a particular focus on the moderating effects of terrain slope and individual functional ability using latent growth curve modelling. Results indicated that the availability of community centres and passive leisure facilities reduced depressive symptoms over time. The protective effects of residential surrounding greenness on depressive symptoms among older adults differed by the terrain slope types. Longitudinal associations between neighbourhood physical environments and depressive symptoms varied between older adults with and without functional limitations. This study has implications for the Ecological Theory of Ageing by identifying the dynamic interplay of environment demands and individual functional ability. Planning policies for building age-friendly neighbourhoods are discussed.

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.

Neighborhood Effects on the Health of Chinese Older Adults: Beyond the Rural and Urban Dichotomy

BACKGROUND AND OBJECTIVES

The associations between physical frailty and depressive symptoms among older individuals were established in the existing literature. Taking the person-environment perspective, we argue that neighborhood environment could either buffer the stress derived from being physically vulnerable or worsen it by adding another layer of stressors in the environmental context when physical health declined. The objectives of this study were to explore to what extent the neighborhood-level characteristics moderate the relationship between physical frailty and depressive symptoms.

RESEARCH DESIGN AND METHODS

Using the China Health and Retirement Longitudinal Study 2011 wave, 6,245 individuals aged 60 years and older were included for analyses. Multilevel mixed-effects models were fitted to examine the moderating effects of urbanicity and neighborhood-level socioeconomic status (SES) on the relationship between frailty and depressive symptoms among older adults, controlling for individual-level characteristics.

RESULTS

Results showed a stronger relationship between deterioration in physical health and depressive symptoms in rural neighborhoods and neighborhoods with lower SES, after controlling for individual-level SES. Also, the moderating effects of the neighborhood-level socioeconomic factors remained after controlling for urbanicity, indicating that neighborhood SES works beyond the rural-urban contexts.

DISCUSSION AND IMPLICATIONS

Findings from this study demonstrate the important roles of neighborhood socioeconomic characteristics in reshaping, and the need to redefine, China's rural-urban dichotomy. The findings also identified neighborhoods with low SES as potential targets for policy and practice to reduce the stress associated with health decline.

Impact of Public Seating Design on Mobility and Independence of Older Adults

Background:Mobility and independence of older adults are influenced by age-related capabilities and limitations, as well as environmental factors such as non-optimum design of public seating (e.g., inappropriate seat height, angle, and compressibility as well as armrests). This study was the first part of a multi-stage investigation of the impact of public seating on older adults. Method:One hundred and six older adults (aged 65 and over) completed an online survey regarding difficulties experienced with standing up from public seating (e.g. frequency; location; type of seating; effects). Results:A majority (59.4%) reported experiencing problems, with seat height the most common issue. Shopping malls, cafes and restaurants, doctor's offices, outdoor locations, and public toilets were the most common locations. Effects included inconvenience, embarrassment, discomfort, pain, and needing help from another person to stand. Discussion:Further research is needed to explore the locations and features of seating that can contribute to this problem.

Age Differences in the Influence of Residential Environment and Behavior on the Life Quality of Older Adults: The Transfer from Physical-Environment to Social-Behavior

With the development of the concept of “ageing-friendly communities”, increasing attention has been paid to the effect of residential environments on the life quality of older adults. However, the logical relationship between residential environment, individual behavior and life quality of older adults has not been clearly revealed. Based on data in Shanghai, China, this study explored the relationships between residential environments and the life quality of older adults in different age groups, and analyzed the mediating role of individual behaviors (neighborhood interaction and outdoor exercise). The findings confirmed that residential environment, neighborhood interactions and outdoor exercise have significant positive effects on the life quality of older adults. Meanwhile, the impact of residential environment on the life quality of older adults is exclusively realized through the mediating role of individual behavior. However, there were significant differences in the model paths among various age groups. With ageing, the positive effects of residential environment on the quality of life gradually weakened, while that of neighborhood interaction gradually improved. The findings prove that the influencing factors on the quality of life of older adults tend to shift from residential environment to neighborhood interaction as the age of residents advances. This knowledge is crucial with regard to the differentiated and accurate design of older communities.

Age-friendly environments and psychosocial wellbeing: a study of older urban residents in Ireland

OBJECTIVE

This article aims to estimate the association between age-friendly urban environments and psychosocial wellbeing in adults aged 55+ living in four Irish cities.

METHOD

Data is from the Healthy and Positive Ageing Initiative 'Age-friendly Cities and Counties Survey' from four cities; Dublin, Cork, Limerick, and Galway (n = 2,094). The Age-friendly Urban Index (AFUI), a perception-based measure of safety, access to services, and walkability, is used to measure urban environment quality on a scale of 35 (least favourable) to 105 (most favourable). Wellbeing was estimated using the following composite measures: quality of life (comprising hedonic (pleasure) and eudaimonic (control, autonomy, self-realisation) wellbeing); affective (depressive mood); and social (loneliness). Multivariate regression analyses (negative binomial and Poisson regression) were used to investigate the association between the AFUI and each wellbeing indicator. Models were fully adjusted for known demographic (age, gender, household structure, marital status), socio-economic (material deprivation, employment/occupation, education), social (social engagement, community activities) and health (self-rated health, mobility limitations) correlates of psychosocial wellbeing.

RESULTS

Older people living in cities with higher AFUI score were more likely to report higher quality of life overall, and higher hedonic and eudaimonic wellbeing. These adults also had lower depressive mood scores and reported lower loneliness levels. Results remain significant in the fully adjusted model.

LIMITATIONS

Causal conclusions cannot be made because of cross-sectional data.

CONCLUSION

This study provides evidence of the relationship between the age-friendliness (safety, services, and walkability) of urban environments and multiple aspects of psychosocial wellbeing for older adults in Ireland.

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.

The Enigma of Gender Differences in an Environment-Behavior-Health Model of Elderly People: The Choice Between Individually and Sociality

Gender difference in the health of elderly people has become an important perspective to consider when studying their health. However, the gender differences in terms of “environment–behavior–health” from the social ecology perspective remain unknown. On the basis of survey data from Shanghai, China, including 2839 samples, this study explored the gender differences of outdoor environment–behavior–activity ability in elderly people from two aspects of the mean value of variables and the path relationship, utilizing the structural equation model analysis method combined with social ecology theory. The results showed that, at the level of the mean of variables, the elderly males had significantly higher mean values than the females in terms of individual behaviors, but had significantly lower values in terms of social behaviors. At the level of path relationships, there were similarities in that the health of elderly males was more likely to be affected by individual factors, whereas that of the females was more effected by social factors. Through the great positive effect of the high-level social behaviors, the health of the elderly females was progressively promoted. The study provided some useful insights for future research, aiming at promoting gender-sensitive urban design.

Health and Social-Physical Environment Profiles Among Older Adults Living Alone: Associations With Depressive Symptoms

OBJECTIVES

We examined differences in depressive symptoms among people 65 and older who live alone, exploring whether these differences are associated with both health and environmental contexts.

METHOD

Data are from the 2006 wave of Health Retirement Study (N = 2,956, age range: 65-104). We used a two-step cluster analytical approach to identify subgroups of health-limitation profiles and environmental profiles. Logistic regression models determined associations between subgroups and depressive symptoms.

RESULTS

Cluster analysis identified four health-profile subgroups (sensory-cognitively impaired, physically impaired, multiply impaired, and healthy) and three different physical-social environmental-profile subgroups (physically average/socially unsupported, physically unsupported/socially supported, and physically supported/socially above average). Compared to members of healthier groups, members of the multiply impaired group were the oldest and were more likely both to live in senior housing and to have depressive symptoms if they lived in a physically average/socially unsupported environment. Members of the sensory-cognitively impaired group were more likely to have depressive symptoms when they lived in a physically unsupported/socially supported environment.

DISCUSSION

Findings regarding the range of both health and social-physical environmental profiles as well as the associations between person-environment profiles combinations (fit) and depressive symptomatology have important policy and intervention implications.

Measuring Age-Friendly Housing: A Framework

An ageing population raises the question of providing adequate housing that enables older people to age in place without losing autonomy and independence. Except for the issue of accessibility, no framework exists that specifically outlines a standard to achieve and, as a result, interventions on existing or on new buildings may be inconsistent without leading to a desired rise in living standards. This research addresses this issue by presenting a framework for the assessment of the age-appropriateness of housing through a number of metrics that detect and identify physical and non-physical features of a home environment to enable ageing in place. The study combines data from a qualitative systematic literature review of 93 papers and qualitative data from structured interviews with four experts in the field. As a result, 71 metrics were identified, divided into eight main domains, to describe the framework. This paper provides an improved understanding of the housing features that enable ageing in place. The tool categorizes and rates qualitative and quantitative aspects that contribute to the age-friendliness of housing, resulting in an easy to adopt assessment framework. This is a valuable means for stakeholders engaged in improving the current housing stock or in constructing new buildings for older people.

Transfer of Promotion Effects on Elderly Health with Age: From Physical Environment to Interpersonal Environment and Social Participation

An important goal of building "age-friendly communities" is to help the elderly to access more opportunities for social participation and better health. However, little is known about the complex relationships between neighborhood environment, social participation, and elderly health. This study examined the mediating role of social participation in the area of neighborhood environment affecting elderly health and explored the discrepancy among different age groups in 43 neighborhoods of Shanghai. Both neighborhood environment and social participation had significant positive effects on elderly health in all the samples. Meanwhile, social participation served as a mediator of the relationship between interpersonal environment and elderly health. Furthermore, remarkably, health promotion effects transferred from the physical environment to interpersonal environment and social participation with age; the influence of physical environment on elderly health decreased with the increase of age, while the influence of interpersonal environment and social participation on the health of the elderly increased with the increase of age. This study found that physical environment, interpersonal environment, and social participation had different effects on elderly health of different ages. Different policies should be applied toward improving the interpersonal environment, optimizing of physical environment, and guiding the community activities.

“We need more things for us”: Being low income and underoccupied in older age

Background.

Low-income older adult populations have increased vulnerability to occupational engagement barriers and poor health outcomes while aging in community settings.

Purpose.

The purpose of this study was to examine the relationship between community navigation and well-being for low-income older adults.

Method.

Community-dwelling older adults ( N = 10) were recruited for this multimethod observational cohort study, which employed GPS data, measures of well-being, and semistructured interviews across 12 months. Grounded theory processes were followed to analyze and integrate the qualitative, quantitative, and spatial data.

Findings.

Findings were three patterns of community navigation. In particular, patterns of being chronically underoccupied were noted for this low-income population. Specific place-based challenges are explained along with strategies used to mitigate these challenges.

Implications.

Supporting community navigation, especially social interaction opportunities, can maximize well-being; and older residents’ occupational participation may be unnecessarily curtailed by geographic, economic, and social factors beyond their control. Community navigation strategies should be considered holistically by occupational therapists as part of interventions supporting aging in place.

How Well Do Seniors Estimate Distance to Food? The Accuracy of Older Adults' Reported Proximity to Local Grocery Stores

(1) Background: Findings from observational studies of relations between neighborhood environments and health outcomes underscore the importance of both objective and perceived experiences of those environments. A clearer understanding of the factors associated with discrepancies between these two assessment approaches is needed to tailor public health interventions to specific populations. This study examined how individual and neighborhood characteristics affect perceptions of supermarket distance, particularly when perceptions do not match objective measures. (2) Methods: Participants were older adults (n = 880) participating in the Senior Neighborhood Quality of Life Study in the Seattle/King County, WA or Baltimore/Washington, DC regions. Two main analyses were conducted. The primary outcome for Analysis I was participants’ geographic information systems (GIS)-based objective network distance to the closest supermarket. Generalized linear mixed models with block group-level random effects were used to assess associations between objective supermarket distance and individual/neighborhood characteristics. The primary outcome for Analysis II was a categorical “accuracy” variable, based on participants’ perceived distance to the nearest supermarket/grocery store relative to the objective distance, assuming a walking speed of 1.0 m/s. Multivariate log-linear models fit neural networks were used to assess influential covariates. (3) Results: Several significant associations with objective distance to the nearest supermarket were observed, including a negative relationship with body mass index (BMI) (95% CI = −45.56, −0.23), having walked to the supermarket in the last 30 days (−174.86, −59.42), living in a high-walkability neighborhood, and residing in Seattle/King County (−707.69, −353.22). In terms of participants’ distance accuracy, 29% were classified as accurate, 33.9% were “Underestimators”, 24.0% “Overestimators”, and 13.2% responded “Don’t Know”. Compared to Accurate participants, Overestimators were significantly less likely to have walked to the supermarket in the last 30 days, and lived objectively closer to a supermarket; Underestimators perceived significantly higher pedestrian safety and lived objectively further from a supermarket; and Don’t Know were more likely to be women, older, not living independently, and not having recently walked to the supermarket. (4) Conclusions: Both modifiable and nonmodifiable factors influence the accuracy of older adults’ perceptions of their proximity to the nearest supermarket. Recent experience in walking to the closest supermarket, along with personal safety, represent potentially modifiable perceived environmental factors that were related to older adults’ accuracy of perceptions of their neighborhood food environment.

Current Status and Policy Planning for Promoting Age-Friendly Cities in Taitung County: Dialogue Between Older Adults and Service Providers

The World Health Organization has promoted age-friendly city (AFC) projects in response to the aging population. Taiwan has also promoted AFC policies. This study was conducted in Taitung County, where 15.37% of the population is older adults in Taiwan. The aim was to understand the perceptions of older adults and service providers with regard to the current status of AFC policies to influence future policies. The participants of this study were older adults and service providers in various regions of Taitung. Quantitative questionnaires were completed by older adults and qualitative interviews were held with focus groups. The older adults were the most satisfied with the AFC domains of “respect and social inclusion” and “community and health services”, and the least satisfied with “transportation” and “civic participation and employment”. Homogeneity existed between the older adults’ satisfaction levels in different regions and the service providers’ opinions; however, there were notable differences between them. Both economic development and the ethnicity of groups in different regions are influential factors that determine the success of government policies. In promoting AFC policies, local governments should consider their applicability based on local conditions and resources to meet the needs of the aging population in rural areas.

Loss of Trust in the Neighborhood: The Experience of Older African Americans in Detroit

Objective

Although evidence suggests that neighborhood conditions are related to stress and health, the processes connecting neighborhood conditions and stress for older minorities is little explored. The purpose of this analysis is to contribute new insights into this issue.

Method

We conducted a qualitative analysis as part of a larger mixed methods study of 100 African Americans aged 55 years and older living in neighborhoods of varying quality in Detroit, Michigan. A subsample of (n = 20) older adults took photographs of bothersome aspects of their neighborhoods and participated in in-depth photo-elicitation interviews. Data were analyzed using a grounded theory approach.

Results

"Loss of trust in the neighborhood" emerged as the core category to explain how older African Americans in our sample experienced neighborhood stressors in their daily lives. Loss of trust in physical, social, and institutional dimensions of the neighborhood contributed to the core category.

Discussion

The life course of neighborhoods and the trust placed in them appears to be intimately connected to the well-being of older African Americans. We therefore hypothesize that a fundamental pathway through which neighborhood stressors are experienced for older African Americans in United States "Rust Belt" cities is the multifaceted loss of trust in the neighborhood.

Healthy urban living: Residential environment and health of older adults in Shanghai

A healthy residential environment, especially for older adults, has emerged as an important issue on political and planning agenda in China. This paper aims to investigate the direct and indirect impact of residential environment on the health of older adults in Shanghai, taking into account health-related behaviours, subjective well-being and socio-demographic factors in one comprehensive conceptual model. Our results show that the residential environment is associated with older adults' health directly, and also indirectly through a series of significant behavioural (physical and social activities) and perceptual (subjective well-being) factors. After combining the direct and indirect association, the results show that good housing and neighbourhood quality and a safe social environment contribute to better subjective, physical and mental health conditions of older adults. In addition, access to cultural facilities is positively related to older adults' mental and physical health and subjective well-being, while a higher proportion of older adults in a neighbourhood appears to promote physical and social activities but not health.

Age-Friendly Communities and Life Satisfaction Among the Elderly in Urban China

This study aims to examine the extent to which older adults’ perceptions of environmental age-friendliness are associated with their life satisfaction. We used a national representative sample ( N = 9,965) with elders aged 60 and above from urban China and structural equation modeling to analyze the relationship among community characteristics, socioeconomic status (SES), and life satisfaction. Results showed that older people’s perceptions of housing conditions, local amenities, and social inclusion were significantly associated with general life satisfaction. Multigroup comparison tests indicated that no disparities in the aforementioned relationships among SES subgroups. However, the socioeconomically disadvantaged elderly population was shown to have the lowest assessment of community age-friendliness. Findings emphasized the potential role of age-friendly communities as having an influential force on older adults’ subjective well-being, regardless of their SES. Meanwhile, policy makers and practitioners should pay special attentions to improve the living environments of disadvantaged elders.

Short- and Long-Term Impacts of Neighborhood Built Environment on Self-Rated Health of Older Adults

Background and Objectives

Proximity to health care, healthy foods, and recreation is linked to improved health in older adults while deterioration of the built environment is a risk factor for poor health. Yet, it remains unclear whether individuals prone to good health self-select into favorable built environments and how long-term exposure to deteriorated environments impacts health. This study uses a longitudinal framework to address these questions.

Research Design and Methods

The study analyzes 3,240 Americans aged 45 or older from the Panel Study of Income Dynamics with good self-reported health at baseline, and follows them from 1999 to 2013. At each biennial survey wave, individual data are combined with data on services in the neighborhood of residence (defined as the zip code) from the Economic Census. The analysis overcomes the problem of residential self-selection by employing marginal structural models and inverse probability of treatment weights.

Results

Logistic regression estimates indicate that long-term exposure to neighborhood built environments that lack health-supportive services (e.g., physicians, pharmacies, grocery stores, senior centers, and recreational facilities) and are commercially declined (i.e., have a high density of liquor stores, pawn shops, and fast food outlets) increases the risk of fair/poor self-rated health compared to more average neighborhoods. Short-term exposure to the same environments as compared to average neighborhoods has no bearing on self-rated health after adjusting for self-selection.

Discussion and Implications

Results highlight the importance of expanding individuals' access to health-supportive services prior to their reaching old age, and expanding access for people unlikely to attain residence in service-dense neighborhoods.

Age-friendly environments and life satisfaction among South Korean elders: person-environment fit perspective

OBJECTIVES

Drawing on the person-environment (P-E) fit perspective, this study examined the role of environment on the well-being of vulnerable older adults in a non-western context. Using the indicators from the World Health Organization's (WHO) framework for age friendly cities (ACF), we examined life satisfaction among South Korean older adults, exploring the extent to which multidimensional environmental characteristics are associated with low socioeconomic status (SES).

METHOD

Using the regionally representative data from the Seoul City-wide needs assessment of middle- and old-aged adults, an analytic sample (N = 1657) focused on community-living individuals aged 65 and older. Multilevel regression models examined interaction between SES subgroups and varying aspects of the environment (i.e. physical, social, and service environment) as related to life satisfaction.

RESULTS

Consistent with the environmental docility hypothesis, members of the most vulnerable subgroup in the Korean context - older adults who are living alone and poor - are more likely to have higher life satisfaction when they have higher levels of support in physical and social environments. Interestingly, a higher level of support in the service environment was related to lower life satisfaction for this subgroup.

CONCLUSION

This study provides an empirical foundation for efforts to identify age-friendly environmental characteristics as modifiable environmental resources that can improve older adults' psychological well-being. As the first attempt to use WHO ACF indicators within the P-E fit perspective in a non-Western context, our study provides a foundation for designing support services or programs that effectively meet the needs of vulnerable older adults.

Effects of Perceived Neighbourhood Environments on Self-Rated Health among Community-Dwelling Older Chinese

In response to the growing number of older people living in cities, the World Health Organization (WHO) introduced the concept of “Age-Friendly Cities” (AFC) to guide the way in designing physical and social environments to encourage active ageing. Limited research has studied the effects of neighbourhood age-friendliness on elderly health outcomes. Using the example of a highly urbanized city in Asia, this study examined the effects of perceived age-friendliness of neighbourhood environments on self-rated health (SRH) among community-dwelling older Chinese. A multi-stage sampling method was used to collect views of community-dwelling older people from two local districts of Hong Kong. A structured questionnaire covering the WHO’s eight AFC domains was developed to collect information on the perceived neighbourhood environments, SRH and individual characteristics. Age-friendliness of neighbourhood was assessed by mean scores of AFC domains, which was used to predict SRH with adjustment for individual and objective neighbourhood characteristics. Furthermore, 719 respondents aged ≥60 years completed the questionnaire, of which 44.5% reported good SRH. Independent of individual and objective neighbourhood characteristics, multiple logistics regressions showed that higher satisfaction on outdoor spaces and buildings, transportation, housing, social participation, and respect and social inclusion was significantly associated with increased odds of reporting good SRH by more than 20% (p < 0.05). Individuals aged 70–79 years, being female, lower education and residents of public or subsidized housing were less likely to report good SRH, after controlling for individual and neighbourhood characteristics. In addition to age, gender, education and housing type, AFC environments have important contributive influence on SRH, after controlling for individual and objective neighbourhood characteristics.

The Role of Age-Friendly Environments on Quality of Life among Thai Older Adults

Studies on the significance of age-friendly environments towards quality of life among older adults have been limited. This study aimed to examine the association between age-friendly environments and quality of life among Thai older adults. Cross-sectional interview survey data were collected from 4183 older adults (≥60 years) using multistage stratified systematic sampling from all four regions in Thailand. The outcome variable was the World Health Organization Quality of Life (WHOQOL-BREF) scale, while independent variables included sociodemographic factors, having a health problem, and neighbourhood age-friendly environment variables. In multivariable logistic regression, significant age-friendly environments predictors of quality of life included walkable neighbourhood, neighbourhood aesthetics, neighbourhood service accessibility, neighbourhood criminal safety, neighbourhood social trust, neighbourhood social support, and neighbourhood social cohesion. The present study confirms the important role of age-friendly neighbourhoods in terms of physical and social environments towards the quality of life of older adults.

The Social Environment’s Relationship With Frailty: Evidence From Existing Studies

Increasingly, policymakers assume that informal networks will provide care for frail older people. While the literature has mainly discussed the role of the family, broader social networks are also considered to be important. However, these social networks can diminish in later life. This systematic review investigates whether the social environment increases the risk of frailty or helps to prevent it. Findings from 15 original studies were classified using five different factors, which denoted five dimensions of the social environment: (a) social networks, (b) social support, (c) social participation, (d) subjective neighborhood experience, and (e) socioeconomic neighborhood characteristics. The discussion highlights that the social environment and frailty are indeed related, and how the neighborhood dimensions and social participation had more consistent results than social support and social networks. Conclusively, recommendations are formulated to contemplate all dimensions of the social environment for further research examining frailty and community care.

Aging in Place of Vulnerable Older Adults: Person-Environment Fit Perspective

Based on the premise that the experience of aging in place is different for vulnerable subgroups of older adults compared with less vulnerable subgroups, we focus on low-income older adults as a vulnerable subgroup and senior housing as an alternative to a conventional, private home environment. Using the 2008 and 2010 waves of the Health Retirement Study, regression models determined the impact of person-environment (P-E) fit between poverty status and residence in senior housing on self-rated health. Consistent with the environmental docility hypothesis, findings show that, among low-income individuals, the supportive environment of senior housing plays a pronounced compensating role and may be a key to successful adaptation in aging. As the first research effort to empirically demonstrate the positive health effects of senior housing among socioeconomically vulnerable elders, our findings provide a much-needed theoretical and practical underpinning for policy-making efforts regarding vulnerable elders.

Self-Rated Health Among Very Old People in European Countries: An Explorative Study in Latvia and Sweden

Objectives: To explore and gain insight into factors related to self-rated health (SRH) among very old people in two European countries. Methods: The study was based on Latvian (n = 301) and Swedish (n = 397) data from the baseline of the Enabling Autonomy, Participation, and Well-Being in Old Age: The Home Environment as a Determinant for Healthy Ageing Survey Study. Besides descriptive statistics, ordinal regression analysis was used to analyze demographic, physical and mental health-related, functional and environmental factors related to SRH in each sample. Results: In both samples, participants with worse perceived physical mobility and more symptoms were significantly more likely to have worse SRH. There were more diverse results regarding other factors in terms of opposite relations to SRH, comparing the two samples. Discussion: Preventive measures and health care should focus on improving and supporting mobility and physical health among older people. Especially in countries with low scores on indicators of health such as Latvia, to minimize health inequalities. More attention should be paid to factors to improve the general health status of the population.

Evaluation of individual aging degree by standard-free, label-free LC-MS/MS quantification of formaldehyde-modified peptides

In this study, a standard-free, label-free LC-MS/MS method is proposed to evaluate aging based on the cross-linkage theory. First, an aging-biomarker screening model was set up in vitro with formaldehyde and the most abundant protein in plasma, human serum albumin (HSA), based on the Maillard reaction. The modification level of peptides cleaved from HSA was investigated using a liquid chromatography tandem mass spectrometry (LC-MS/MS) method with an (18)O-labeling technique. One formaldehyde-insensitive peptide and six formaldehyde-sensitive peptides that would be verified for being putative peptide-biomarkers were screened via the in vitro aging model. These six putative biomarkers were then preliminarily verified by plasma samples with the aldehyde-insensitive peptide serving as the internal standard. The verification results indicated that the peptides LDELRDEGK and VFDEFKPLVEEPQNLIK showed a significant quantitative difference among young/mid-aged/elderly groups of people.