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

Age-friendliness of community and sleep quality: The role of mental health

BACKGROUND

The relationship between age-friendliness of community (AFC), mental health and sleep quality is still unclear.

METHOD

Using a sample of Chinese older adults aged ≥60 years (N = 3099), this cross-sectional study aimed to investigate the serial mediating roles of resilience and depressive symptoms between AFC and sleep quality through structural equation modeling. Additionally, this study examined the association between each AFC dimension and sleep quality stratified by mental health, using the multivariable linear regression models. Mental health was categorized based on levels of resilience and depressive symptoms. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The AFC dimensions included housing, transportation, built environment, social participation, as well as social inclusion and health services.

RESULTS

Resilience and depressive symptoms completely mediated the relationship between AFC and sleep quality through three paths: (1) the independent mediating role of resilience or (2) depressive symptoms, and (3) the serial mediating roles of resilience and depressive symptoms. Furthermore, higher AFC and higher age-friendliness in transportation dimension as well as social inclusion and health services dimension were associated with better sleep quality among older adults with high levels of mental health.

CONCLUSIONS

Resilience and depressive symptoms played serial mediating roles in the relationship between AFC and sleep quality. For older adults with low or medium levels of mental health, a community-based approach may not be recommended.

LIMITATIONS

This cross-sectional study used self-reported sleep measures and could not make cause inferences.

Communication Ecology Model of Successful Aging in Indonesian Context

The communication ecology model of successful aging (CEMSA) as a part of aging studies from a communication perspective was replicated in the Indonesian context. The CEMSA provided a specific perspective from communication scholars about the successful aging process. The study of CEMSA has grown significantly to demonstrate the importance of the interactive-communication process to propagate and enhance aging studies. However, there has been no specific aging study from a communication perspective, especially from communication scholars in the Indonesian context. This study applied all concepts, variables, measurements, and analyses from the replicated study. The result showed that seven domains of communication about aging may be relevant to predict successful aging from a negative effect and positive effect, and efficacy toward aging. The model showed that the uncertainty and combination of a negative and positive effect in seven domains of communication about aging could construct the efficacy and success of the aging process. The model with seven domains of communication about aging could be proved while the data were gathered not by self-report.

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.

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.