Locked down by inequality: Older people and the COVID-19 pandemic.

This paper develops the argument that post-COVID-19 recovery strategies need to focus on building back fairer cities and communities, and that this requires a strong embedding of 'age-friendly' principles to support marginalised groups of older people, especially those living in deprived urban neighbourhoods, trapped in poor quality housing. It shows that older people living in such areas are likely to experience a 'double lockdown' as a result of restrictions imposed by social distancing combined with the intensification of social and spatial inequalities. This argument is presented as follows: first, the paper examines the disproportionate impact of COVID-19 on older people, highlighting how the pandemic is both creating new and reinforcing existing inequalities in ageing along the lines of gender, class, ethnicity, race, ability and sexuality. Second, the paper explores the role of spatial inequalities in the context of COVID-19, highlighting how the pandemic is having a disproportionate impact on deprived urban areas already affected by cuts to public services, the loss of social infrastructure and pressures on the voluntary sector. Finally, the paper examines how interrelated social inequalities at both the individual and spatial level are affecting the lives of older people living in deprived urban neighbourhoods during the pandemic. The paper concludes by developing six principles for 'age-friendly' community recovery planning aimed at maintaining and improving the quality of life and wellbeing of older residents in the post-pandemic city.

Are neighbourhoods age-friendly? Experiences of older Surinamese adults in the Netherlands during the COVID-19 pandemic

Older Surinamese adults in the Netherlands have been disproportionately affected by COVID-19. The ability to provide support in response to older adults' needs contributes to the age-friendliness of neighbourhoods and may be especially important during public health emergencies such as a pandemic. In this study, older Surinamese adults' experience of neighbourhood age-friendliness, as indicator of a vital city, in general and during the COVID-19 pandemic was explored. Based on the eight age-friendly domains identified by the WHO, semi-structured interviews were conducted with 17 Surinamese adults (≥70 years) living in Rotterdam and the Hague. Views on the age-friendliness of the neighbourhoods in general and during the pandemic were asked. Despite differences in resilience within and across neighbourhoods, this study showed that certain age-friendly features can support older Surinamese adults in the Netherlands during a pandemic. These findings have implications for policymakers and health service providers seeking to develop age-friendly neighbourhoods, as an indicator of a vital city, in general and during a pandemic. © 2023 The Authors

Age-Friendly Community Interventions for Health and Social Outcomes: A Scoping Review.

To address the numerous challenges associated with aging, increased attention has been given to the development of age-friendly cities and communities (AFCC) to promote healthy aging and social participation. However, limited evidence exists for addressing both health and social needs through the AFCC framework. We address this gap by conducting a scoping review of the interventions that target both health and social outcomes within the purview of the AFCC framework. The results showed that many of the successful interventions used a partnership model and behavioral change theories to inform the program design and implementation. The results also indicated that social participation and engagement played a key role in making the interventions successful. However, the results revealed that the literature is dominated by person-focused approaches. Future research should focus more on evaluating environmental-focused interventions and develop a holistic framework that combines both person- and environment-based approaches to healthy aging.

Toward Age-Friendly Policies: Using the Framework of Age-Friendliness to Evaluate the COVID-19 Measures from the Perspectives of Older People in the Netherlands.

Protective measures that were taken during the COVID-19 pandemic, targeted older people as an at-risk group. The objective of this article is to investigate how older people in the Netherlands experienced the mitigation measures and whether these measures endorse and promote the idea of an age-friendly world. The WHO conceptual framework of age-friendliness, which consists of eight areas, has been used for a framework analysis of 74 semi-structured interviews with older Dutch adults, that were held during the first and the second wave of the pandemic. The results of the analysis indicate that the areas of social participation, respect and inclusion were affected most, and the measures concerning communication and the health services were experienced as age-unfriendly. The WHO framework is a promising tool for assessment of social policies, and we suggest its further development for this purpose.

Using an age-friendly university lens to explore community member engagement during the pandemic.

The COVID-19 global pandemic forced institutions of higher education to adapt quickly to virtual connection platforms to maintain ties with their learners. After transitioning to virtual programming, the number of participants in our lifelong learning program more than quadrupled. As a member of the Age-Friendly University (AFU) global network, we saw this as an opportunity to continue expanding our age-inclusivity efforts and capitalized on this engagement by inviting attendees to participate in a brief online survey related to several of the AFU principles. Respondents requested, although not exclusively, continued virtual access to programming. Results emphasized the need for flexible and diverse access points, supported by age-inclusive campus infrastructure, for continuity in respondents engaging with the university post-pandemic. Our path forward is discussed, highlighting successful strategies by other AFU global partners.

Co-creating inclusive spaces and places: Towards an intergenerational and age-friendly living ecosystem.

Introduction: Evolving aging societies, ongoing digitalisation and circumstances of COVID-19 are changing living conditions for growing older. There is an increased urgency to view public health with a focus on integrating people of all ages into the matrix of opportunities afforded in their communities. This study initiates the conceptualization of an intergenerational, age-friendly living ecosystem (AFLE) to enhance public health planning. Methodology: A participatory study was conducted using a multi-methods approach. Six virtual co-creation sessions (n = 35-50 participants), alongside a mainly open-ended INTERGEN survey designed specifically for this study (n = 130) were conducted to conceptualize multilevel ideas for building intergenerational age-friendly places using Bronfenbrenner's ecological systems model. At the height of COVID-19, virtual applications (Zoom, Moodboard) and case studies, creative methods (drawing, photography, storytelling and spotlight sessions) were applied to engage academic and non-academic participants between ages 5 - 80+ years, across eight countries. Sessions were video-recorded with visual themes captured by a graphic facilitator. The survey covered issues of multigenerational interactions; intergenerational and age-friendly place features; place safety; and necessary stakeholders required for creating intergenerational and age-friendly places. Data were reflexively analyzed using a team approach to thematic analysis. Results: Findings present both the thematic analysis of Virtual Co-creation Camps (VCCs) and the INTERGEN survey results. These findings are addressed in three overarching categories that highlight the necessary characteristics of AFLEs as suggested by the VCC participants and survey respondents: (i) Sensory factors: feeling and emotion as starting points for physical design; (ii) Physical and digital factors in designing AFLE spaces and places; and (iii) Socio-cultural factors: tackling ageism and exclusion as part of the solution. Discussion: The analysis resulted in a pathway toward enhanced understandings on how multi-generations can better interact with fluctuating organizational domains (industry, voluntary, academic and public sectors) in urban and rural settings to facilitate intergenerational connectivity. Through processes of co-creation, an AFLE proof of concept and roadmap for public health planning was developed to support and provide opportunities for people as they age to reap the socioeconomic benefits of their local and virtual communities and help them become well integrated, valued and contributory members of society.

A scoping review protocol of age-friendly practices during the COVID-19 pandemic.

Background: Actions focused on age-friendly environments contribute to promote and maintain older people's functional ability and may enable them to contribute to their communities and enjoy life. As such, age-friendly practices require collaboration between diverse stakeholders across multiple sectors responsible for natural, built, and social environments, which can be particularly relevant during public health emergencies when socio-ecological vulnerabilities become more salient and may disproportionally affect older people. This paper presents a protocol for a scoping review aiming to investigate the breadth of evidence concerning the development, implementation, and evaluation of age-friendly practices during the COVID-19 pandemic. The protocol sets out the objectives, methods, and dissemination plans for the review. Methods: The scoping review will be conducted in line with the Joanna Briggs Institute (JBI) scoping review methodology. We will search databases (PubMed, Web of Science, Embase, CINAHL, Scopus, PsychNet) and grey literature sources. Publications relating to practices across the 8 domains of the World Health Organization's age-friendly cities and communities' framework will be included. A tabular data extraction tool will be used to facilitate a narrative synthesis of results. Ethics and dissemination: Ethical approval is not required as the methods proposed for this scoping review consist of collecting publicly available data. Findings will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) and submitted to a journal for academic dissemination. Lay dissemination plans include an infographic and a blog-style article presenting our core results. Conclusion: The publication of this protocol allows for transparency in the systematic process of a scoping review focused on age-friendly practices during COVID-19. Findings emerging from the scoping review will provide insights into the evidence available regarding age-friendly activities during COVID-19 and may inform future age-friendly practices during public health emergencies and beyond.

The Positive Impact of Public Health Engagement in Healthy Aging During the COVID-19 Pandemic

The COVID-19 pandemic has made starkly clear that the public health system in the United States can significantly impact the health and well-being of older adults. Prior to the pandemic, healthy aging was not prioritized by public health agencies, despite the growing population of individuals ages 65 and older. Trust for America's Health, in partnership with The John A. Hartford Foundation, has been working to expand the public health role in healthy aging, as well as better coordinate with age-friendly movements, both of which have contributed to a more efficient and effective COVID-19 response. © 2022 American Society on Aging.

Active and healthy ageing in urban environments: laying the groundwork for solution-building through citizen science.

Urban age-friendly initiatives strive to promote active and healthy ageing by addressing urban influences that impact individuals as they age. Collaborative community partnerships with multi-level stakeholders are crucial for fostering age-friendly initiatives that can transform urban community health. Employing a citizen social science (CSS) approach, this study aimed to engage older adults and stakeholders in Birmingham, UK, to (i) identify key urban barriers and facilitators to active and healthy ageing, and (ii) facilitate collaboration and knowledge production to lay the groundwork for a citizen science project. Older adults (n = 16; mean age = 72(7.5 SD); 11 female) and community stakeholders (n = 11; 7 female) were engaged in six online group discussions, with audio recordings transcribed and thematically analysed to present key urban barrier and facilitator themes. Ageism, winter, technology and safety were barriers identified by both groups. Outdoor spaces and infrastructure, transportation, community facilities, and Covid-19 pandemic were identified as barriers and/or facilitators. Older adults identified the ageing process as a barrier and diversity of the city, health and mobility and technology as facilitators. For stakeholders, barriers were deprivation and poverty, gender differences, and ethnicity, whereas age-inclusive activities were a facilitator. Organic and active opportunities for older adults and stakeholders to connect, co-produce knowledge on urban environments and share resources presented foundations of solution-building and future collaboration. CSS effectively facilitated a range of stakeholders across local urban spaces to collaborate and co-produce ideas and solutions for enhancing local urban environments to promote active and healthy ageing.

Planning urban age-friendly environments requires engagement with local residents, service providers and decision-makers. This is important for developing joint actions, urban initiatives and allowing these individuals to share their experiences, needs and resources. Citizen social science (CSS) can engage residents and stakeholders to directly shape social research aiming to improve urban environments. This study engaged 16 older adults over the age of 60 and 11 stakeholders to identify urban features that influence active and healthy ageing in Birmingham, UK. Using six online discussion groups, the key urban barriers and facilitators were identified by older adults and stakeholders, who also checked the findings to confirm they represent the discussions accurately. Urban barriers and facilitators included health and mobility, ageism, outdoor spaces and infrastructure, transportation, technology, Covid-19, and the lack or presence of community facilities and activities. During discussion groups, both older adults and stakeholders connected to share information about local organizations, resources, websites for free activities or research, and provide solutions for each other's barriers. CSS effectively engaged older adults and stakeholders to collaborate and create knowledge together for improving local urban environments in Birmingham.

Responding to Local Needs by Mobilizing Community Assets: Age-Friendly Community Initiatives During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: Age-friendly community initiatives (AFCIs) strive to make localities better for long and healthy lives by fostering improvements across social, physical, and service environments. Despite the heightened need for community supports during the coronavirus disease 2019 pandemic, very little research has addressed the work of AFCIs in the context of this crisis. We aimed to develop theory on how AFCI core teams have contributed to community responses during the pandemic, as well as what contexts have influenced the initiatives' ability to contribute. RESEARCH DESIGN AND METHODS: As part of a multiyear, community-partnered study on the development of philanthropically supported initiatives in northern New Jersey, we conducted qualitative interviews with 8 AFCI core teams during the winter of 2020-2021. The interviews focused on the leaders' efforts at that time, with probing questions concerning enabling factors for their community responses. We analyzed the data using an inductive coding process encompassing open, axial, and subcoding. RESULTS: The analysis indicated four distinct roles of AFC core groups: good community partner, creator, advocate, and communications broker. We further found that AFC leaders primarily drew on three types of capital-human, social, and tangible-to enact these roles, oftentimes in cumulative ways. DISCUSSION AND IMPLICATIONS: We interpret our study's findings and their implications by integrating insights from theories of social impact. We further highlight the importance of continued research on community-centered approaches to promote aging in community during times of societal crisis, and otherwise.

Creating Interprofessional Readiness to Advance Age-Friendly U.S. Healthcare

A successful interprofessional faculty development program was transformed into a more clinically focused professional development opportunity for both faculty and clinicians. Discipline-specific geriatric competencies and the Interprofessional Education Collaborative (IPEC) competencies were aligned to the 4Ms framework. The goal of the resulting program, Creating Interprofessional Readiness for Complex and Aging Adults (CIRCAA), was to advance an age-friendly practice using evidence-based strategies to support wellness and improve health outcomes while also addressing the social determinants of health (SDOH). An interprofessional team employed a multidimensional approach to create age-friendly, person-centered practitioners. In this mixed methods study, questionnaires were disseminated and focus groups were conducted with two cohorts of CIRCAA scholars to determine their ability to incorporate learned evidence-based strategies into their own practice environments. Themes and patterns were identified among transcribed interview recordings. Multiple coders were used to identify themes and patterns and inter-coder reliability was assessed. The findings indicate that participants successfully incorporated age-friendly principles and best practices into their own work environments and escaped the silos of their disciplines through the implementation of their capstone projects. Quantitative data supported qualitative themes and revealed gains in knowledge of critical components of age-friendly healthcare and perceptions of interprofessional collaborative care. These results are discussed within a new conceptual framework for studying the multidimensional complexity of what it means to be age-friendly. Our findings suggest that programs such as CIRCAA have the potential to improve older adults’ health by addressing SDOH, advancing age-friendly and patient-centered care, and promoting an interprofessional model of evidence-based practice.

Age-Friendly Built Environment

DefinitionAge-friendly built environments have been promoted by the World Health Organisation (WHO, Geneva, Switzerland) under the Global Age-friendly Cities (AFC) movement in which three domains are related to the built environment. These are: housing, transportation, outdoor spaces and public buildings. The aim is to foster active ageing by optimising opportunities for older adults to maximise their independent living ability and participate in their communities to enhance their quality of life and wellbeing. An age-friendly built environment is inclusive, accessible, respects individual needs and addresses the wide range of capacities across the course of life. Age-friendly housing promotes ageing in familiar surroundings and maintains social connections at the neighbourhood and community levels. Both age-friendly housing and buildings provide barrier-free provisions to minimise the needs for subsequent adaptations. Age-friendly public and outdoor spaces encourage older adults to spend time outside and engage with others against isolation and loneliness. Age-friendly public transport enables older adults to get around and enhances their mobility. For achieving an age-friendly living environment, a holistic approach is required to enable independent living, inclusion and active participation of older adults in society. The eight domains of the AFC movement are not mutually exclusive but overlap and support with one another.

Age-Friendly Nursing Homes: Opportunity for Nurses to Lead.

Age-Friendly Health Systems is a movement to ensure that all care and support for and with older adults across all settings is age-friendly care. Age-Friendly Health Systems provide staff, leadership, and care partner education based on the 4M Framework (What Matters, Medications, Mentation, Mobility). Nursing homes and other settings are often left out of local, state, or federal strategic plans on aging. In addition, limited quality and quantity of nursing home staff impact new program implementation. We consider how programs and services to support older adults can create and sustain an Age-Friendly Ecosystem, including a meaningful role for nursing homes.

Age-friendly communities during the time of COVID-19: a model for rapid community response.

With the COVID-19 epidemic disproportionately impacting older adults, cities across the United States (U.S.) and the world scrambled to meet the needs of their older residents. Members of the World Health Organization's Age-Friendly Communities (AFCs) network rely on cross-system community collaborations and resident voices to create age-friendly social, built, and service environments. These key elements of AFCs place them in a unique position to quickly identify needs of older residents, launch short-term targeted interventions, and support integration of new programs into existing systems for post-crisis sustainability. This essay discusses how one age-friendly community applied key tenets of the Centers for Disease Control's rapid response team model to meet the immediate, short-term needs of older residents for social connection, food, personal protective equipment (PPE), emergency preparedness, and technology utilization. Sustainability of the rapid response interventions was supported through the relationships and structures created by the AFC.

Guidelines to contain disease outbreaks are helpful when responding to outcomes of outbreaks.Age-friendly communities core values align with the tenants of disaster response.Age-friendly communities are well positioned to respond to the consequences of COVID-19.

Designing Robots for Elderly from the Perspective of Potential End-Users: A Sociological Approach.

The proposed research aims to investigate the problem of age-friendly robot designing from the perspective of the potential end-users. The initial objectives addressed three main issues: how the elderly envision robots and their knowledge on technological development; age-friendly robot design; the elderly's involvement in the robot design process. The empirical material analyzed are the results of in-depth interviews with people aged 70+. A sociological approach is proposed, based mainly on criticism of writing and the analytical and synthetic method. The theoretical framework is the perspective of an ageing society and technogerontology. The sociological approach enables better understanding of the sensitive problems of age-friendly robot designing from the individual point of view. It is concluded with a conceptual discussion on designing robots for the elderly. In particular, it is revealed how these issues could help in shaping social consensus about age-friendly technologies.

‘Farmers Don’t Retire’: Re-Evaluating How We Engage with and Understand the ‘Older’ Farmer’s Perspective

Globally, policy aimed at stimulating generational renewal in agriculture is reported to pay meagre regard to the mental health and wellbeing of an older farmer, overlooking their identity and social circles, which are inextricably intertwined with their occupation and farm. This paper, in probing this contentious issue, casts its net across what could be deemed as disparate literatures, namely connected to transferring the family farm and social gerontology, in order to determine what steps could be taken to reassure older farmers that their sense of purpose and legitimate social connectedness within the farming community will not be jeopardised upon handing over the farm business to the next generation. A number of practical ‘farmer-sensitive’ actions that can be taken at both policy and societal level are subsequently set forth in this paper to help ease the fear and anxiety associated with ‘stepping aside’ and retirement from farming amongst older farmers. A particular focus is placed on social and emotional wellbeing benefits of being a member of a social group reflecting farmer-relevant values and aspirations in later life. The potential of the multi-actor EIP-AGRI initiative and the long-established livestock mart sector in facilitating the successful rollout of a social organisation designed to fit the specific needs and interests of the older generation of the farming community is then outlined. In performing this, the paper begins a broad international conversation on the potential of transforming farming into an age-friendly sector of society, in line with the World Health Organization’s (WHO) age-friendly environments concept.

Impacts of biophilic design on the development of gerotranscendence and the Profile of Mood States during the COVID-19 pandemic

To live in a good mood is not only a key consideration for future age-friendly communities, but also a critical necessity for positive ageing. Despite growing evidence of correlations between contact with nature and stress reduction, little is known about the effect of nature integration in indoor environments. Thus, this study aimed to answer the following research questions: (a) How do biophilic characteristics of home environments correlate with older adults' experience of the multiple levels of the theory of gerotranscendence? and (b) What is the relationship between these experiences and the mood states of these older adults? The study was based on a comparative analysis to scrutinise the impact of the COVID-19 pandemic on these questions. The data were gathered through questionnaires with 450 older adults aged between 65 and 95 years, and stratified by the biophilic characteristics of their living environments: indoor biophilic, outdoor biophilic and non-biophilic. Two sets of data were collected with the same participants, respectively, before the COVID-19 pandemic (June to October 2018) and during the COVID-19 pandemic (June to October 2020). It found that the biophilic characteristics of home environments are correlated dynamically with older adults' ageing experience and mood states. The study indicates that outdoor biophilic features facilitate the recovery of tension mood effects of the COVID-19 pandemic, whereas indoor biophilic features facilitate recovery from depression and anger. Copyright © The Author(s), 2021. Published by Cambridge University Press.

Age-Friendly Health Care: A Systematic Review.

BACKGROUND: Health care provided to older adults must take into account the characteristics of chronic diseases and the comorbidities resulting from ageing. However, health services are still too oriented towards acute situations. To overcome this problem, the World Health Organization (WHO) proposed a set of Age-Friendly Principles that seek to optimize the provision of health care for this population. This article aims to understand how such Principles are considered in the implementation of age-friendly health care worldwide. METHODS: A systematic review was conducted to synthesize the literature on age-friendly health care in accordance with the PRISMA recommendations in the PubMed, Web of Science, and Scopus databases. RESULTS: The research identified 34 articles, with only seven recognizing the WHO Principles and only four using the implementation toolkit. In addition, in the context of primary care, three studies recognize the WHO Principles, but only two use the toolkit. CONCLUSIONS: The WHO Principles are being implemented in health care, but in a smaller scale than desired, which reveals possible flaws in their dissemination and standardization. Thus, a greater scientific investment in age-friendly health care should be considered, which represents a greater operationalization of the Principles and an evaluation of their effectiveness and impacts.

Prisons, Older People, and Age-Friendly Cities and Communities: Towards an Inclusive Approach.

This original and ground-breaking interdisciplinary article brings together perspectives from gerontology, criminology, penology, and social policy to explore critically the nature and consequences of the lack of visibility of prisons, prisoners, and ex-prisoners within global research, policy and practice on age-friendly cities and communities (AFCC), at a time when increasing numbers of people are ageing in prison settings in many countries. In addition, the COVID-19 pandemic continues to pose challenges in the contexts both of older peoples' lives, wellbeing, and health, and also within prison settings, and thus it is timely to reflect on the links between older people, prisons, and cities, at a time of ongoing change. Just as there is an extensive body of ongoing research exploring age-friendly cities and communities, there is extensive published research on older people's experiences of imprisonment, and a growing body of research on ageing in the prison setting. However, these two research and policy fields have evolved largely independently and separately, leading to a lack of visibility of prisons and prisoners within AFCC research and policy and, similarly, the omission of consideration of the relevance of AFCC research and policy to older prisoners and ex-prisoners. Existing checklists and tools for assessing and measuring the age-friendliness of cities and communities may be of limited relevance in the context of prisons and prisoners. This article identifies the potential for integration and for cross-disciplinary research in this context, concluding with recommendations for developing inclusive research, policies, and evaluation frameworks which recognise and include prisons and older prisoners, both during and after incarceration.