Enhancing Community Participation through Age-Friendly Ecosystems: A Rapid Realist Review

Establishing Age-friendly Communities in the Philippines: The Need to Empower Senior Citizens beyond the "Card"

   The Philippines’ transition toward an aging population calls for various agencies to address the evolving and diverse needs of older people. Notably, the Filipino subscription to filial piety, which emphasizes respect and caring for older people, encourages families and communities to promote the welfare of our senior citizens. However, a recent article noted that Filipinos’ caring behaviors toward their older family members might be slowly fading, as evidenced by increasing cases of family abandonment/abuse and emerging negative perceptions about aging. Hence, it is imperative for the government to support older people across settings where they continue to live and function.    The National Commission of Senior Citizens (NCSC), created in 2019, serves as the lead agency for promoting the welfare and protection of Filipino older adults. Meanwhile, various policies for senior citizens commonly involve socioeconomic provisions, such as social pension, retirement benefits, mandatory insurance coverage (PhilHealth), and discount/tax incentives on several purchases or services. Other relevant programs are also reported, including protection from abuse and neglect, promotion of health and wellness, reinforcement of roles in nation-building, navigation of health and social services, and coordination of various agency services for older people. Nonetheless, there is limited data on the implementation and evaluation of these programs on the ground. A multisectoral approach, ensuring that all stakeholders’ voices are heard and appropriate resources are pooled, is crucial to foster healthy aging.    It is imperative to empower communities to integrate various factors that influence the well-being of older people. Thus, the World Health Organization (WHO) advocates the development of age-friendly environments (AFEs) to reinforce the physical and mental capacities, including other health-related attributes of older people throughout their life course. There are eight interconnected domains to promote AFEs: community and healthcare, communication and information, social participation, respect and social inclusion, civic participation and employment, housing, outdoor buildings and spaces, and transportation. This indicates that supporting older people requires systems thinking, which includes identifying and managing individual needs, existing community resources, and environmental factors that impact their overall functioning.    It should be noted that each domain is instrumental in an age-friendly environment. For instance, adequate spaces and facilities could provide venues for health promotion, social interaction, and training for older people and their families. Transportation modes that consider the needs of people with disabilities could contribute to social inclusion and access to health and social services. Residential facilities could assist persons who are abandoned/homeless and those who require longterm care. Meanwhile, resources to enhance the digital literacy of older people for communication and information could also promote civic engagement, healthcare access, and social participation. Through a whole-society approach, AFEs could foster aging in place, wherein older people can live safely and independently in their households and communities.    Six elements are required to develop a national framework for age-friendly communities: (1) partnerships, networking, and stakeholders; (2) leadership and strategic thinking; (3) human, financial, institutional, and cultural resources; (4) capacitybuilding; (5) knowledge, research, and innovation; and (6) monitoring and evaluation. Last year, the NCSC has started designing a framework for age-friendly environments in the Philippines. Developing an AFE national program could take months to years, as consultations with various partners, mapping and optimizing resources, and developing training and evaluation programs involve iterative and continuous processes. The Philippines can also learn from other countries on how to plan for and sustain age-friendly communities. However, AFE model cases are mostly from high-income countries like the US, the UK, Spain, and Japan, of which have different contexts from the Philippines. Therefore, developing age-friendly environments in the country should consider the unique contexts where older people live. Various agencies (local, national, international; public and private) in health, social care, labor, transport, housing, education, and media should be tapped for comprehensive organizational support. Representations from older people, families, caregivers, people with disabilities, and other interest groups are also important for inclusive stakeholder consultations.    The role of academic institutions in developing age-friendly communities cannot be overemphasized, as research could enable understanding of local contexts, creation of evidence-based policies, and guidance to policy implementation/evaluation through scientific and ethical processes. Hence, educational institutions should explore collaborative partnerships with their local communities to facilitate co-production of knowledge that can be utilized in developing AFEs. Enabling the new generation of researchers to work with older people and other stakeholders, could also provide opportunities to combat ageism and develop advocacies for marginalized populations. As suggested by Felipe-Dimog et al., schools are conducive venues to leverage the Filipino value of family orientation and respect toward older people. Apart from being research and innovation hubs, educational institutions should serve as centers for values formation toward age-friendliness.    Direction from the national government is paramount to developing and supporting age-friendly communities in the Philippines. As previously described, leadership and strategic thinking in AFEs is needed to ensure that the right stakeholders are included, sufficient resources are availed, appropriate capacity-building activities are provided, relevant research projects are conducted, and pragmatic evaluation methods are utilized. The NCSC, as the primary agency tasked to foster age-friendly communities in the country, should ensure the above processes are fulfilled in the best way possible. Financial support is also crucial for maintaining partnerships, hiring additional staff, building spaces, and creating other facilities to make agefriendly communities a reality. As devolution continues, the government should aid low-resource settings to design and sustain age-friendly environments. Recognizing that the country is nearing the aging population, supporting senior citizens should go beyond giving discounts or free services. Ultimately, a strong political will is the key to ensure that all older people are cared for and provided with resources to successfully age in their communities.

Healthy Ageing in Malaysia by 2030: Needs, Challenges and Future Directions

This Editorial addresses the critical need for developing a healthy ageing society in Malaysia by 2030. With the country's elderly population projected to increase significantly, the article explores current challenges, including healthcare disparities, a shortage of geriatric specialists and malnutrition. It evaluates existing policies and highlights successful international and local initiatives, suggesting specific recommendations to improve healthcare infrastructure, healthy ageing support and technological integration. Emphasising the importance of engaging private sectors, non-governmental organisations (NGOs) and community groups, this Editorial calls for a collaborative approach to address the economic and cultural aspects of ageing. This comprehensive strategy aims to ensure a resilient, healthy and inclusive environment for Malaysia's ageing population by 2030.

The Experiences of Skilled Nursing Staff in Memory Care Units During the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

The novel coronavirus disease 2019 (COVID-19) resulted in the need for multiple mitigation strategies. The impacts of these safety measures were felt more extremely by healthcare providers. This qualitative study focused on the experiences of staff in skilled nursing facilities, specifically in locked memory care units, during the first year of the COVID-19 pandemic.

RESEARCH DESIGN AND METHODS

This study used a basic interpretive methodology. In-depth interviews were conducted with skilled nursing staff members who worked in a locked memory care unit during the 2020 calendar year. Thematic analysis was used to organize and interpret the data.

RESULTS

A total of 11 participants provided data that resulted in themes around reasons for working on a locked memory care unit, experiences working with people who have behavioral and psychological symptoms due to dementia, training, outcomes of shared experiences, outcomes of policy changes, management support, and suggestions for a future pandemic.

DISCUSSION AND IMPLICATIONS

The results of this study may have implications for skilled nursing facilities with locked memory care units that continue to grapple with the realities of providing care during a pandemic. Providing appropriate training, social support, and appropriate protective equipment are among the suggestions.

Individual and Community-Contextual Level Factors Associated With Wellbeing Among Older Adults in Rural Zambia

Objective: This article aims to identify individual and community-contextual level factors associated with the wellbeing of older adults (50 years and older) in rural Zambia. Methods: Data from the nationally representative 2015 Living Conditions Monitoring Survey (LCMS) was used. Employing multilevel mixed effects, the individual and community-contextual factors on wellbeing were determined. Results: Overall, 31.7% of rural older adults perceived their wellbeing as good. Both individual and community-contextual level factors are associated with the wellbeing of older adults in rural communities. At the individual level, wellbeing was associated with higher education attainment. Community-contextual factors significantly associated with wellbeing included improved housing, access to piped tap water within the premises, own charcoal or income to purchase firewood. Conclusion: The findings foreground the imperative to analyse both individual and community-contextual level factors of wellbeing to generate and present evidence for investments in education across the life course and for the development of infrastructure towards increasing the wellbeing of rural older adults. Additionally, the results provide a basis for planning by devising policies and programmes for older people to thrive and for no one to be left behind regardless the setting.

Valuing and sustaining older peoples' day care services

BACKGROUND

Unprecedented ageing and growth of the global population of older people is predicted. Between independent and residential care, day care is an essential part of a population-based strategy to support ageing well in place.

AIMS

To describe experiences of older people attending day care services.

METHOD

Using the qualitative method, two focus groups were completed in 2018 in a region of Ireland with 12 participants. Interviews were audio-recorded and transcribed; grounded theory guided the subsequent analysis.

FINDINGS

Older people valued their participation in day care, describing the 'home from home' experience positively. Community nurses from the local public health nursing service played a key role in fostering and sustaining participation.

CONCLUSIONS

National commitment to population-based age friendly environments is required to facilitate the wellbeing of a growing older demographic.