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

[Dietary diversity, anthropometric status and biochemical profile of centenarians of the Nicoya Peninsula, Costa Rica, and their offspring]

BACKGROUND AND OBJECTIVE

Social relationships, physical activity and diet have been proposed as responsible for longevity; however, many of these conditions have changed in modern societies. The objective of this study was to identify if the anthropometric status, biochemical profile and diet of Nicoyan centenarians is different from that of their decency and if the quality and diversity of the diet of these Costa Ricans differs from that of adults from urban areas of the same country.

MATERIALS AND METHODS

Anthropometric, biochemical and dietary assessments were carried out on 120 adults residing in the Nicoya Peninsula, including centenarians, their children and grandchildren. The data were analyzed using descriptive and inferential statistics.

RESULTS

There is a significantly lower percentage of excess weight, central adiposity and blood lipids in Nicoyan centenarians compared to their children and grandchildren. The consumption of «Dairy» and «Other fruits» is higher in centenarians than in their descendants. Centenarians showed a higher dietary diversity index (DDI) compared to other age categories, and they also showed a higher DDI and a significantly more diverse diet than the urban population of Costa Rica.

CONCLUSION

Nicoyan centenarians presented a better lipid and glycemic profile than their offspring, they have lower weight and a better quality and diversity of diet than their relatives and than adults from the urban area of Costa Rica.

Redefining Age-Friendly Neighbourhoods: Translating the Promises of Blue Zones for Contemporary Urban Environments

The longevity and healthy ageing observed in Blue Zones offer valuable insights for contemporary urban neighbourhood planning and design. This paper reviews the age-friendly features of the built environment in Blue Zones, aiming to translate these insights into actionable strategies for urban neighbourhood development. Employing a systematic literature review and Convolutional Neural Networks (CNNs) analysis of Google Street View imagery, this study assesses the built environments in Blue Zones, including housing, public spaces, and transportation systems. Key findings highlight the presence of adaptable housing, building designs that foster a connection with nature, and semi-public spaces that encourage social interaction and physical activity. A notable emphasis on walkability and limited public transport access was observed. The CNN analysis corroborated these findings, providing a quantitative view of age-friendly features. This research contributes to the academic discourse in urban planning and design by providing practical insights for developing age-friendly neighbourhoods, inspired by Blue Zones. It concludes by offering policy advice and future research directions for creating sustainable and inclusive urban environments conducive to ageing populations.

Lifestyle Medicine: An Antidote to Cardiovascular Diseases

Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn't been much decline in heart disease related mortality in the US since 2010. Hypertension and diet induced risk continue to be the leading causes of cardiovascular morbidity. Even with the excessive mortality associated with the COVID-19 pandemic, in 2020, heart disease remained the leading cause of death. Given the degree of disease burden, morbidity, and mortality, there is an urgent need to redirect medical professionals' focus towards prevention through simple and cost effective lifestyle strategies. However, current practice paradigm and financial compensation systems are mainly centered disease management and not health promotion. For example, the financial value placed on 3-10 min smoking cessation counseling (.24RVUs) is 47-fold lower than an elective PCI (11.21 RVUs). The medical community seems to be enamored with the latest and greatest technology, new devices, and surgical procedures. What if the greatest technology of all was simply the way we live every day? Perhaps when this notion is known by enough, we will switch to this lifestyle medicine technology to prevent disease in the first place.

Navigating the Healthcare Conundrum: Leadership Perspective from a Premier Healthcare Organization in Loma Linda's Blue Zone

Navigating the healthcare conundrum in the Blue Zone of Loma Linda, California, requires understanding the unique factors that make this region stand out in terms of health and longevity. But more important is understanding the healthcare system sustaining the Blue Zone in Loma Linda, California. In an era marked by soaring healthcare costs and diminishing reimbursement rates, hospitals and physicians face an unprecedented challenge: providing excellent patient care while maintaining financial sustainability. This leadership perspective publication paper delves into the multifaceted struggles encountered by healthcare and hospital leaders, exploring the root causes, implications, and potential solutions for this complex issue. As we examine the evolving healthcare landscape, we aim to shed light on the critical need for innovative approaches to sustain the future of healthcare excellence in one of the five original Blue Zones.

Stakeholder perspectives on the preferred service ecosystem for senior citizens living at home: a qualitative interview study

BACKGROUND

Most senior citizens want to live independently at home as long as possible. The World Health Organization recommends an age-friendly community approach by transforming the service ecosystem for senior citizens and basing it on the question "What matters to you?". However, there is limited research-based knowledge to determine the characteristics of the preferred service ecosystem from the perspectives of multiple stakeholders. Therefore, the aim of the study was to gain a deeper understanding of multiple stakeholder perspectives on the preferred service ecosystem for senior citizens living at home.

METHODS

Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study in 2019 and 2020: senior citizens, carers, healthcare professionals, and managers. Data were analysed according to qualitative content analysis.

RESULTS

Overall, there was considerable correspondence between the four stakeholder groups' perspectives on the preferred service ecosystem for senior citizens. Six themes were developed: (1) "self-reliance - living independently at home as long as possible"; (2) "remaining active and social within the community"; (3) "support for living at home as long as possible"; (4) "accessible information and services"; (5) "continuity of services"; and (6) "compassionate and competent healthcare professionals".

CONCLUSIONS

In order to adapt and meet changing needs, the preferred service ecosystem should support senior citizens' autonomy through interpersonal relationships and involvement. Healthcare managers and decision makers should consider a broader range of practical and social support services. Municipalities should plan for and develop age-friendly infrastructures, while healthcare professionals should rely on their compassion and competence to meet senior citizens' needs.

Early Recognition of Overweight Hyperglycaemia May Improve Clinical Outcomes in Type 2 Diabetes

Diabetes is the ninth leading cause of death, directly accounting for 1.5 million deaths annually worldwide. Despite several breakthrough discoveries, little progress has been made in type 2 diabetes outcomes over the past 100 years. Younger age (below 60 years), a diet high in calories and processed food, and severe obesity (body mass index >35 kg/m²) may identify reversible beta cell dysfunction. Much of the clinical presentation pertains to flooding the body's adaptive limits with overnutrition. Recognizing this as a global societal trend brought about by lifestyle changes, sedentary work, mental stress and unlimited access to calorie-dense foods is crucial. Insulin resistance and genetic abnormalities cannot account for the dramatic increase in diabetes, from only 1% five decades ago to nearly 10% today. Obesity - and not insulin resistance - is at the core of the problem. As well as hyperglycaemia, end-organ damage can also be reversed with diet and weight loss in many affected individuals. We present the evolution of our understanding and compelling reasons to reframe diabetes in the severely obese to what it really is - overweight hyperglycaemia. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles. The objective of this review is to better understand global trends and the potential to improve outcomes by reframing the diabetes narrative towards remission. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles.

Developing Indicators of Age-Friendliness in Taiwanese Communities through a Modified Delphi Method

This study developed indicators of age-friendliness for communities in Taiwan that conform to international standards by referring to the World Health Organization Checklist of Essential Features of Age-Friendly Cities and Taiwan's existing indicators. The first stage of the research was based on the WHO's framework and involved a literature review to identify candidate indicators. In the second stage, experts' opinions were collected through a modified Delphi method, and the indicators were screened and revised on the basis of their importance, community enforceability, and generality. The third stage focused on practical feasibility. External parties were invited to offer their opinions regarding the indicators, which were adjusted accordingly. After three rounds of review and re-examination based on the modified Delphi method, the final set of indicators comprised five core indicators and five optional indicators. These indicators can be used to monitor various aspects of communities and determine their age-friendliness.

Incorporating the Co-Creation Method into Social Innovation Design to Promote Intergenerational Integration: A Case Study of a Public Square

With the COVID-19 pandemic sweeping the world, there is an increased focus on intergenerational relationships, community mental health issues, and well-being in community contexts. This paper assesses the effectiveness of a co-creation approach for intergenerational integration at the theoretical level. The study used a collaborative co-creation design method in the community design process to explore whether the participation of community residents of all ages in addressing community issues promoted communication and alleviated stereotyping between the various generations. This study was conducted in Shanghai's Hongqiao New Village square, where we conducted participatory research and co-creation workshops in response to the demand for the use of the public space as a location for social interactions. The results showed that intervention in community creation through collaborative design is conducive to promoting friendly relations among different age groups, forming a sense of social security and thus enhancing social well-being. Finally, this paper combines practical cases and theoretical models of collaborative co-creative design approaches to promote the intergenerational integration of communities and is summarized from the input and output parts as well as the influencing factors and constraints of the collaborative co-creative. In addition, it provides new ideas on how to improve intergenerational relationships and form a positive and sustainable community mental health environment in the future.

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.