Attitudes to ageing mediates the relationship between perception of age-friendly city and life satisfaction among middle-aged and older people in Macao: a cross-sectional study

BACKGROUND

Societal attitudes toward ageing play a significant role in shaping one's ageing experience, and an age-friendly environment can potentially enhance the life satisfaction of older individuals. The objective of this study is to examine the role of attitudes to ageing as mediators in the association between the perception of an age-friendly city and life satisfaction among middle-aged and older adults.

METHODS

Using the tools of Age-Friendly City (AFC) criteria, Attitudes to Ageing Questionnaire (AAQ) to measure psychosocial loss, psychological growth, and physical change, and Satisfaction with Life Scale (SWLS) to assess the level of life satisfaction among community-dwelling middle-aged and older people in Macao. Multiple mediation analysis was performed to test the mediation effect.

RESULTS

A total of 543 participants were included in this study. The average score of AFC was 4.25, the total scores of psychosocial loss, physical change, and psychological growth were 24.06, 29.00, and 26.94 respectively. The total score of SWLS was 24.06. There was a partial mediation of attitudes to ageing in the relationship between perception of age-friendly city and life satisfaction. The mediation effect explained 56.1% of the total effect of AFC to life satisfaction.

CONCLUSION

The development of an age-friendly city can help improve the public's view on ageing, and thus improve their life satisfaction. It is important for government to consider the improvement of people's attitudes to ageing when developing policies regarding AFC.

Implementing age-friendly policies in China: Assessing the impact on older adults' self-rated health

Using prefecture-level policy documents (2008-2018) and the China Health and Retirement Longitudinal Study (2011-2018), this study used fixed-effects regressions to examine the associations between the maturity of two age-friendly policies, i.e., old age care (OAC) and preferential treatment (PT) policies for older adults, and the self-rated health (SRH) of older adults. We use policy duration and policy density to measure policy maturity. The results showed positive relationships exist between the density of OAC and PT policy and older adults' SRH, whereas long policy duration often relates to lower SRH. Policy duration and policy density work synergistically. Furthermore, heterogeneity analyses indicated that older adults aged over 75 years, male, those with physical or mental impairment, and living in rural areas and in the first- and second-tier cities benefit significantly from denser OAC policy. The SRH of older adults suffering from physical disabilities or mental problems and living in rural areas is positively associated with denser PT policy. From a policy perspective, our findings suggest that age-friendly policies should be updated over time and be place- and characteristic-tailored.

Age-friendly neighbourhood environment, functional abilities and life satisfaction: A longitudinal analysis of older adults in urban China

The construction of age-friendly neighbourhoods is a priority for practice and policy to promote active ageing and increase life satisfaction for older adults. However, there has been a paucity of longitudinal evidence on the interaction effects of age-friendly neighbourhood environment and functional abilities on life satisfaction among older adults in urban China. This study makes the first attempt to examine the effect of person-environment fit on life satisfaction by the accumulative effects of age-friendliness of the baseline neighbourhood environment (measured within the WHO Age-Friendly City framework) on functional abilities and life satisfaction trajectories and the long-term effects of functioning changes on life satisfaction, drawing from four waves of longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) and latent growth curve modelling. Results indicated that the age-friendliness of transportation was positively associated with functional abilities, and housing was the primary factor that shaped life satisfaction at the baseline. Better maintenance of functional abilities could promote life satisfaction over time. For older adults living in recently built neighbourhoods, social environment factors such as associations and facilities for social participation were more important in functional abilities, and communication and information were more important in life satisfaction. For those living in neighbourhoods built before 2000, physical environment factors such as transportation were essential in functional abilities, and housing was more essential in life satisfaction; health-related facilities and services at baseline exerted a cumulative effect on maintaining functional abilities in the long run. Our findings inform policymakers about how to effectively allocate public resources to enhance older adults' life satisfaction in the Chinese urban context.

The Incidence of Falls and Related Factors among Chinese Elderly Community Residents in Six Provinces

This cross-sectional study classified the factors related to falls among residents ≥ 60 years old in China in order to provide evidence for the prevention of falls in the elderly. A total of 2994 participants were enrolled, and the correlations between social demography, physical health, self-health management awareness, family support, and fall risk were analyzed. Factors influencing falls were classified by location, cause, and the activity during falls. Suffering from osteoarthropathy (OR = 1.761, 95% CI: 1.234-2.513, p < 0.05), depression or anxiety (OR = 1.896, 95% CI: 1.331-2.700, p < 0.001), household size > 2 (OR = 1.806, 95% CI: 1.042-3.130, p < 0.05), and poor self-assessed health (OR = 1.478, 95% CI: 1.107-1.972, p < 0.01) were risk factors. Higher participation in community health programs (OR = 0.522, 95% CI: 0.298-0.912, p < 0.05) and spousal support (OR = 0.909, 95% CI: 0.841-0.981, p < 0.05) were protective factors. Falls were divided into the following categories: stairs/hallway (vision, attention problems), bath/toilet (vision, attention problems, slipping), indoor housework (dizziness, leg weakness), and outdoor activities (attention, surface problems). While acknowledging that the personal physical and mental health of the elderly may lead to falls, community support, accelerated transformation of housing, and the construction of barrier-free environments play an important role in reducing the risk of falls.

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.

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.

Assessment of Environmental Demands of Age-Friendly Communities from Perspectives of Different Residential Groups: A Case of Wuhan, China

Age-friendly communities (AFCs) are an important measure for fostering active aging. The key to achieving an age-friendly living environment is to construct or renovate it according to the residents’ demands. To date, very few studies have attempted to delve into the AFCs’ environmental demand from different groups’ perspectives. Based on the theory of place attachment, the aim of this paper is to explore the demand diversity of different groups for the AFC environment. This study employs the nonparametric test and the Ordinal Priority Approach (OPA) to investigate the demands from the residents’ perspectives, and is enhanced by incorporating experts’ opinions. The empirical analysis shows that residents have a high level of demand for the physical environment (indoor and outdoor) and social environment (community services and social participation). At the same time, experts advocate the importance of using digital technologies to support people aged 45–65 who have higher requirements for a community environment than older adults. The findings also show that other backgrounds, such as gender, living arrangements, and year of the community establishment, lead to different demands. However, the impact of residents’ education level, occupation, income, and self-care ability on the environmental demands is low. Based on the research findings, the paper provides some practical suggestions for the future design and development of AFCs.

Association between Age-Friendliness of Communities and Frailty among Older Adults: A Multilevel Analysis

An age-friendly environment is one of the measures of healthy aging. However, there is scarce evidence of the relationship between the age-friendliness of communities (AFC) and frailty status among Chinese older adults. This study aims to examine this relationship using a multilevel analysis with the data of a cross-sectional study conducted among 10,958 older adults living in 43 communities in four cities in China. The validated Age-friendly Community Evaluation Scale and Chinese frailty screening-10 Scale (CFS-10) were used to measure AFC and Frailty. Multilevel regression analyses were performed to examine the relationship between the AFC in two assessments of individual- and community-level and frailty status. After controlling for individual-level socio-demographic, health status, and lifestyle variables, compared with older adults in the lowest quartile of the individual-level perception of AFC, the frailty odds ratios for those in the top three quartiles were 0.69 (95% confidence interval [CI]: 0.56–0.83), 0.75 (95% CI: 0.61–0.91), and 0.56 (95% CI: 0.48–0.74). However, there was no association between the community-level AFC and frailty. A higher level of age-friendliness in the community is associated with lower frailty odds. Therefore, building age-friendly communities may be an important measure to prevent frailty among Chinese older adults.

On becoming a dementia-friendly community: An empirical study of the individual factors that predict openness towards dementia-friendly communities

BACKGROUND AND OBJECTIVES

Evidence suggests that limited public awareness and dementia-related stigma can create barriers to community inclusiveness. This study explored the relation between public knowledge of dementia, attitudes towards people with dementia, experience with dementia and openness towards dementia-friendly communities.

RESEARCH DESIGN AND METHODS

Two-hundred and twenty-nine members of the public completed a cross-sectional online survey with three established measures [Alzheimer's Disease Knowledge Test, Attitudes Towards People with Dementia scale and Understanding of Health Problems survey] and one exploratory scale [Openness Towards Dementia-Friendly Communities]. An existing 'mild' dementia vignette was used to evaluate dementia recognition. Factors contributing to correct dementia recognition (knowledge, exposure to dementia, education and gender), worry about developing dementia (knowledge, exposure and respondent age), and openness towards dementia-friendly communities (knowledge, exposure and attitudes) were examined through group comparisons and a multiple linear regression.

RESULTS

Consistent with the literature, the respondents had poor knowledge, reasonably good dementia recognition, and mostly positive attitudes towards people with dementia. None of the proposed factors were significantly associated with correct dementia recognition, and only gender was significantly associated with dementia worry. Knowledge and attitudes towards people with dementia (not exposure) were significant independent predictors of openness towards dementia-friendly communities.

DISCUSSION AND IMPLICATIONS

The expansion of dementia-friendly communities will require further investment in awareness-raising initiatives to improve dementia knowledge and attitudes in the community. This study shows the importance of these factors in the broader community's openness towards dementia-friendly communities.

Neighborhood Attributes and Well-Being Among Older Adults in Urban Areas: A Mixed-Methods Systematic Review

Expanding urbanization rates have engendered increasing research examining linkages between urban environments and older adults' well-being. This mixed-methods systematic review synthesizes the evidence for the influence of urban neighborhoods' attributes on older adults' well-being. We searched for literature published up to December 2020 across six databases and performed quality assessment and thematic analysis. The results, based on 39 identified studies, showed that natural areas in neighborhoods and a sense of community are the attributes most often associated with positive effects on well-being. Transit-related variables, urban furniture, and access to healthcare are also positively related to well-being. Neighborhoods may promote well-being more effectively when these elements are considered. However, almost half of the studies did not include all environmental dimensions simultaneously, and self-reported instruments were largely preferred over more objective assessments of the environment. Future research should thus holistically examine physical, social, and service-related attributes to produce more robust evidence.

Street Usage Characteristics, Subjective Perception and Urban Form of Aging Group: A Case Study of Shanghai, China

Against the background of the aging trend in China, construction and regeneration strategies for an aging-friendly built environment are becoming common, led by urban governments, and public street spaces are the focus of these strategies. Exploring such planning and design strategies can help to improve the social welfare of the aging population and meet their diverse needs. Thus, this paper, through analyzing the determinants of the elderly’s needs, examines the relationship between spatial perception and street form, using Shanghai, in China, as a case study. This study contributes to the current literature in two ways: first, it constitutes the first attempt to build a needs hierarchy for aging people in a Chinese developed city; second, our statistical analysis involves large-scale population surveys, which helps us to comprehensively and deeply understand the impact of detailed street forms on the elderly’s various spatial perceptions. Our results indicate that the renovation of street space in different areas of cities can be improved by the control of street form, to meet the diverse needs of the local aging group.

Perceived neighborhood environment, social capital and life satisfaction among older adults in Shanghai, China

This study examined the mediator role of social capital on the association between perceived neighborhood environment and life satisfaction among older adults in urban China, and further tested the moderating effect of gender in the above paths (i.e., from neighborhood environment to life satisfaction; from neighborhood environment to social capital; from social capital to life satisfaction). We used quota sampling approach to recruit 472 respondents aged 60 years old or older in Shanghai in 2020. From the perspective of structural equation modeling, multiple group analysis was conducted to examine the proposed hypotheses. The measurement model of social capital was well established in urban Chinese community contexts. Based on the whole sample, the results of the mediation model showed that social capital played a mediation role in the association between neighborhood environment and life satisfaction. Furthermore, the results of multiple group analysis showed that the association between neighborhood environment and cognitive social capital was only significant among older women. The findings highlight the role of neighborhood environment and social capital in building age-friendly communities.

A Policy Framework for Producing Age-Friendly Communities from the Perspective of Production of Space

Given various hindrances in the macro context, how to efficiently develop age-friendly community policies requires further research. Currently, such kinds of frameworks are lacking. This paper aims to develop a policy framework to minimise cost and resolve conflict of interest between different generations in age-friendly community development. The study adopted a scientometric method to review the theoretical development of age-friendly community studies. Firstly, with a search for the keywords “age-friendly” and “community” on Web of Science, 72 English academic papers were found containing explicit theories. Most of the studies were conducted in the Global North. Then, a mixed analytical method was used to find a suitable theory, “the production of space”, to develop the policy framework. Lastly, a policy framework was developed to overcome barriers to age-friendly community development strategically. Echoing previous studies, this paper proposes a way to counter financial austerity in age-friendly initiative investment and balance the consideration for older and younger populations in urban development. For practice, the policy framework can provide a reference for more efficient age-friendly community policymaking in different regions. For future research, the framework provides a model for more empirical studies considering the social dynamics in age-friendly community development.

Between Poverty and Energy Satisfaction in Polish Households Run by People Aged 60 and Older

The household sector contributes significantly to a country’s energy consumption. Energy carrier expenses are the highest expenditures in Polish household budgets. Households run by individuals aged 60 and older are heavily burdened with energy expenditures. The scientific aim of the research is to present and assess housing conditions, with particular emphasis on energy poverty in households run by individuals aged 60 and older. Multivariate statistical analyses were used to conduct the research objectives (cluster methods, variance methods, regression methods). This paper identifies a new index—one that has been applied to the situation in Poland. Households that consist of elderly people are strongly diversified in terms of housing conditions (including energy conditions). There are concerns that some households are not able to access energy services that are required to satisfy basic human needs, particularly individuals with low levels of education, living on social benefits, with low disposable incomes, or living in the countryside. Households represented by men aged 60 and older have better energy supply than households run by women. The older the individual representing the household, the greater the likelihood that his/her energy service needs are not met.

A Study on Supply-Demand Satisfaction of Community-Based Senior Care Combined with the Psychological Perception of the Elderly

Based on Maslow’s hierarchy of needs theory and customer satisfaction theory, we constructed a satisfaction model for supply–demand satisfaction for community-based senior care (SSCSC) combined with the psychological perspective of the elderly, and four dimensions of basic living needs (BLNs), living environment (LE), personal traits (PTs), and livability for the aged (LA) were selected to construct the model. The data were obtained from 296 questionnaires from seniors over 50 years old (or completed by relatives on their behalf, according to their actual situation). Twenty-two observed variables were selected for the five latent variables, and their interactions were explored using structural equation modeling. The results showed that LA was the most significant factor influencing SSCSC, and it was followed by BLNs and LE. PTs did not show a direct effect on LA, but they could have an indirect effect on SSCSC through influencing BLNs and LE. Based on the current state of community aging satisfaction, we propose to establish a community elderly care service system based on the basic needs of the elderly population, providing differentiated and refined elderly care services and improving the level of aging-friendly communities. This study provides references for the government to formulate relevant policies and other supply entities to make strategic decisions and has important implications for further enhancing community elderly services to become an important part of the social security system for the elderly.

Knowing, Being and Co-Constructing an Age-Friendly Tāmaki Makaurau Auckland

A third of Aotearoa New Zealand’s increasingly ageing population resides in Tāmaki Makaurau Auckland. This most populous cosmopolitan urban area in the country is also home to the largest Polynesian population of any global city. Sprawling across a North Island isthmus inclusive of Hauraki Gulf islands, 70% of the city region is rural, whilst almost 90% of the ethnically diverse residents live in urban areas. Members of Auckland Council’s Seniors Advisory Panel (SAP) advocated for, and in 2018 secured unanimous support from the governing body to resource an Age-friendly City (AFC) Project. This case study inquiry applied bricolage methodology to provide diverse contextual perspectives of this unique Polynesian setting, prior to exploring interview narratives of three SAP members who served two consecutive terms (six years) as AFC advocates. Weaving insights gleaned from their interview transcripts responding to relational leadership prompts about their age-friendly advocacy with the findings from the council’s AFC Community Engagement report highlighted the achievements and challenges of the evolving AFC Project. Service-learning recommendations include co-developing: (1) A sustainable co-governance framework for an independent steering group that embodies the values and principles of Te Tiriti o Waitangi to enable empowered active ageing for all residents; (2) A succession plan that enables the timely transfer of knowledge and skills to empower incoming SAP members.

Current status on the ability of the elderly in rural China: implications for future nursing and policy

Background

Aging is a global problem, and the ability assessment of the elderly plays an important role in the formulation of pension policies. It's necessary to evaluate the ability of the elderly in rural China to provide insights into future nursing care and policy making.

Methods

The elderly in 20 rural villages were selected by convenience sampling. We used "Elderly Ability Evaluation Form" issued by the Ministry of Civil Affairs of China as survey tool. The characteristics and score differences of the elderly of different ability level were compared and analyzed. And logistic regression analyses were conducted to identify the potential risk factors for disability in the elderly.

Results

A total of 2,878 elders were included, of which there were 1,916 elders with intact ability, 866 elders with mild disability, 42 elders with moderate disability, 54 elders with severe disability. The incidence of disability among respondents was 33.43%. There were significantly statistical differences in the dimensions of activities of daily living, mental state, perception and communication, and social participation among elders with intact ability, mild, moderate and severe disability (all P<0.05). The age, education level, marital status and living situations were all corrected to the scores on the activities of daily living, mental state, perception and communication, and social participation among elders (all P<0.05), and the elderly with age ≥75 years, illiteracy, unmarried and live alone had higher risk for disability (all P<0.05).

Conclusions

The current situation of the ability level of the elderly in rural China seems to be worrying, and it's necessary to establish a long-term nursing care system and aging policy to meet the needs of the elderly with regards to those potential influencing factors.

Associations of City-Level Active Aging and Age Friendliness with Well-Being among Older Adults Aged 55 and Over in Taiwan

This study aims to identify the typology of city-level active aging and age-friendliness across cities in Taiwan and examine their effects on well-being in terms of life satisfaction (aged 55 and over) and health-related quality of life (HRQoL) (aged 65 and over) among older adults. The data were from the 2017 Taiwan Senior Citizen Condition Survey. Available indicators of Taiwan’s Active Aging Index and city age-friendliness were selected, and mixed linear models were analyzed. Active aging cities were classified into four categories—content, developed, participatory, and pioneer—and age-friendly cities into insecure, infrastructural, and tranquil. Life satisfaction was rated higher in content and participatory cities compared with the pioneer city, and related to individuals’ active aging status. Physical HRQoL was rated higher in infrastructural and tranquil cities, compared with insecure cities. City types of active aging and age-friendliness have different effects on well-being, but the effects are weaker than those of individuals’ characteristics.

What Can Buffer the Impact of Social Support on Chinese Older Adults' Life Satisfaction?

This study aims to test the moderating effects of home health care, home-help service, and older adults' attitudes toward aging on the relationship between social support and life satisfaction among Chinese older adults. The study used a sample of 5,578 Chinese home-dwelling older adults. Multiple linear regression analyses were performed to test the hypothesized effects along with gender and Hukou type differences. The results show that home health care significantly buffers the impact of social support on life satisfaction, and this buffering effect remains same across gender groups and Hukou groups. The findings of the study provide unique and contemporary theoretical and practical implications.

Evaluation of an Age-Friendly City and Its Effect on Life Satisfaction: A Two-Stage Study

Due to the ageing of the world's population, age-friendly cities are emerging to promote active ageing by optimising opportunities for health, participation and safety, in order to improve the quality of life of older people. Despite initiatives in different countries, there is a lack of empirical research exploring their impact on older people. The objective of this study is to evaluate an age-friendly city by analysing its relationship with life satisfaction, taking into account the age cohort variables of the elderly and whether they live alone or with someone else. A two-stage study, in which 66 subjects participated in the qualitative analysis (focus groups) in Stage I and 203 of the quantitative analysis (survey methodology) or Stage II. Despite the differences found in the different groups of elderly persons, for all of them the domains of outdoor spaces and buildings, and community support and health services, are significantly related to life satisfaction, with the latter showing itself to be a predictor of such satisfaction. It is important to take into account the different groups of elderly persons, so as to be able to establish suitable specific actions. This study aims to make a contribution to the development of public policies that influence the life satisfaction of the elderly.

How the Urban Neighborhood Environment Influences the Quality of Life of Chinese Community-Dwelling Older Adults: An Influence Model of “NE-QoL”

Due to functional impairment and low mobility, the sphere of activities of older adults often shrinks and they rely on their living environment more. Especially for urban community-dwelling older adults who are aging in place, the urban neighborhood environment affects their quality of life (QoL) heavily. This study aims to explore how the urban neighborhood environment affects QoL of community-dwelling older adults and develop a mediation model called “Neighborhood Environment-Quality of Life (NE-QoL)” for community-dwelling older adults. The reliability test is applied to test and modify the questionnaire based on cross-sectional data collected from the survey, the multiple regression analysis is used to identify significant influence relations between variables of neighborhood environment and dimensions of the QoL, mediation effects are assumed and tested by the mediation analysis in SPSS, and then the “NE-QoL” is developed to reveal the detailed influence path between the urban neighborhood environment and QoL of community-dwelling older adults. The “NE-QoL” model reveals seven variables of the urban neighborhood environment, which influences the QoL of community-dwelling older adults significantly, and three mediation effects exist in the influence path, making clear the understanding about the relationship between neighborhood environment and the QoL of community-dwelling older adults. It provides valuable retrofit guidelines of the neighborhood environment for improving QoL of community-dwelling older adults.

Access to Employment, Volunteer Activities, and Community Events and Perceptions of Age-Friendliness: The Role of Social Connectedness

The aim of this study was to investigate the direct and indirect effects of access to employment, volunteer opportunities, and community events on older adults' perception of age-friendliness and feelings of connectedness. Data were from an age-friendly community survey conducted in a Midwestern city in the United States. We analyzed the responses of 264 older adult residents (50 years and older) using path analysis. Results showed that access to community events, job resources, and connectedness were predictors of older adults' perceptions of age-friendliness of their community, and that connectedness mediated the relationship between access to community events and perceived age-friendliness. The findings help to refine the concept of an age-friendly community from older adults' perspectives and emphasize the importance of fostering interactions through community events to enhance older adults' feelings of connectedness.