What the pandemic and its impact on the mobility and well-being of older people can teach us about age-friendly cities and communities.

From the start of the pandemic, questions were raised concerning how the pandemic could change or even transform relationships to our living environments. COVID-19 has had a disproportionate impact on the health and well-being of older people due to the increased risk of severity of the disease with both advancing age and associated co-morbidities. Restrictions on the movement of older people have also been more severe, with many countries imposing restrictions based on chronological age. In Portugal, confinement measures were targeted at older persons in terms of sheltering-at-home orders for those over 70. This paper looks at the impact of these restrictions on the lives of older people and asks what we can learn from the pandemic about the concept of age-friendly cities (WHO, 2007a). We look at the lived experience of older people to understand how their well-being and mobility were impacted during the crisis and its aftermath. The study was undertaken in four urban areas: Aveiro, Coimbra, Lisbon, and Faro. Data was collected using semi-structured interviews analysed using a process of thematic coding based on the eight pillars of the WHO's Age-Friendly City Checklist (WHO, 2007b). The results are discussed using conceptualisations from the new mobilities paradigm: existential mobility, connection and (im)mobility governance, offering new ways of thinking about age-friendliness in and out of crisis.

Vulnerability in context; hard numbers, tricky words and grey areas for gerontology.

At the start of the COVID-19 pandemic, the Portuguese government identified those aged 70 or more as a risk group, placing a special duty of protection on them to shelter-at-home. This paper asks how Portuguese municipalities, using Facebook posts, communicated the risk to older adults and to what extent ageist stereotypes were found in the language and frames employed. Over 3800 Facebook posts made by Portuguese municipalities concerning older adults and COVID-19 published between March and July 2020 were analyzed. Language counts for age-related words were used in a first round of content analysis followed by a process of thematic analysis. Findings indicate that the language used to address Portuguese older adults could be understood as ageist in terms of homogenizing older people as a fixed group. The communication of risk was often conflated with the vulnerability narrative already observed in the extant literature. However, context- and culture-specific themes of 'solidarity', 'inter-relatedness', 'duty of care' and 'support for those living in isolation' were also found. The study highlights the extent to which language, culture and context are intertwined with our understanding of age, aging and ageism. It provides a culturally-specific case study, which challenges both gerontological interpretations of vulnerability and neoliberal frames which focus responsibility on the individual regardless of age. We argue that these alternative frames echo the emerging discourse of mutual aid and solidarity, providing a wider context for addressing vulnerability in a health crisis.

Geografia das respostas sociais para as pessoas idosas em Portugal / Geography of social care for older people in Portugal

Resumo: Este estudo analisa a distribuição geográfica das respostas sociais dirigidas à população idosa em Portugal continental, e compara os padrões espaciais dos equipamentos dos sectores público, solidário e lucrativo. Os resultados mostram uma distribuição heterogénea e uma tendência para a concentração espacial das estruturas do sector privado em áreas mais urbanizadas. Conclui-se que a crescente liberalização do sector constitui um risco para a equidade territorial dos cuidados sociais.

Abstract: This study analyses the geographical distribution of social care for older adults in mainland Portugal, and compares the spatial patterns of public, non-profit and profit institutions. The results show a heterogeneous distribution and a tendency towards spatial concentration of private sector structures in more urbanised areas. We conclude that the increasing liberalisation of the sector constitutes a risk to the territorial equity of social care provision.

Daily Mobility and Social Interactions Among Community-Dwelling Older Adults With Pet Dogs: A Scoping Review.

Dogs are part of many people's lives and are involved in interventions to improve the well-being of older adults in institutional settings. However, the literature on the impact of pet dogs on community-dwelling older adults is still relatively limited. This study mapped the impact of having a companion dog on the daily mobility and social interactions of community-dwelling older adults using a scoping review. Electronic databases were searched, and studies written in English, Portuguese, and Spanish that were published in a peer-reviewed journal were identified. After a careful review, 26 eligible studies were identified, and relevant findings were extracted. The main findings indicated that having a dog may promote or hinder daily mobility and social interactions and that having a dog is about routines and sharing affection. More research is needed to clarify what makes having a companion dog key to promoting active and healthy aging.

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.

Local governments' use of social media during the COVID-19 pandemic: The case of Portugal.

While the use of social media by local governments has gained relevance in recent years, crises are critical situations that reinforce the need to reach citizens to disclose information, demonstrate the government's commitment, and increase the citizens' level of preparedness and awareness of resources. This paper examines the factors that influenced local governments' e-disclosure during the first wave of the COVID-19 pandemic. To accomplish this objective, we systematically tracked every post published by the official Facebook page of 304 Portuguese municipalities between March 2 and July 5, 2020. The findings show that financial autonomy is the main predictor of e-disclosure, factors varied on the different phases of the pandemic's first wave, and sociodemographic factors became more prevalent as explanatory factors when the crisis worsened. Our study may help increase the level of preparedness during possible future crises. In particular, establishing communication strategies for prolonged public health crises, making financial resources available for the accomplishment of such strategies, and reducing the digital divide can contribute to more effective disclosure. Future research should explore the dynamics of disclosure during public health crises. This study also highlights the need to incorporate time in research that focuses on the determinants of e-disclosure that could also be tested in normal times.

The twin faces of ageism, glorification and abjection: A content analysis of age advocacy in the midst of the COVID-19 pandemic.

While the government responses to the COVID-19 pandemic have varied across the globe, there has been a unifying cry from academia and public health professionals warning of the detrimental effects of attaching our understanding of this new threat to our already ageist attitudes. What is inescapable is that COVID-19 has an age-related risk component and the latest data shows that risks start to rise for people from midlife onwards. As governance agencies, professional practice, and academia work towards assessing, communicating, and addressing this risk, we ask: are existing gerontological conceptualisations of ageism appropriate for this exceptional situation and what is being (re)produced in terms of an aged subjectivity? Following van Dyk's (2016) critique of gerontology's 'othering' through both 'glorification' (third age) and 'abjection' (fourth age), a content analysis of statements and policy documents issued in response to COVID-19 provides evidence of well-meaning and inadvertent ageism through homogenizing language, the abjection/glorification binary within 'old age', and the power binary constructed between age and an age-neutral midlife. The paper concludes with reflections on future directions for ageism research beyond COVID-19.

Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological study.

OBJECTIVES: Studies have suggested that material deprivation is strongly associated with negative health outcomes, and lower usage of various levels of healthcare. We aim to analyse geographical access to emergency medical services (EMSs) and hospital emergency units by EMS in relation to deprivation in the Lisbon Metropolitan Area (LMA), Portugal. DESIGN: This study estimates road network-based access times from the centroids of statistical sections (census block groups equivalent) to locations of EMS and hospital emergency services. Each statistical section has been linked to a Material Deprivation Index (MDI). A non-parametric analysis of variance (ANOVA) was undertaken to compare MDI-linked statistical sections in terms of access to emergency care. Geographical access analysis was conducted for 2018. PRIMARY OUTCOME MEASURE: Road network-based access time (in minutes) for EMSs to statistical sections and then on to emergency units in hospitals. RESULTS: Overall, 82.4% of the LMA population is located less than a 10 min drive from an EMS without transport, and 99.1% from an EMS with transport. Travel time from EMS with transport to hospital is potentially less than 20 min for 95.2% of the population. However, 63.1% of residents living beyond a 30 min threshold (total time from emergency call to hospital arrival) are in areas with very high MDI (18.8% in high MDI, 13.3% in medium MDI, 4.7% in low MDI, 0% in very low MDI). Kruskal-Wallis ANOVA confirms discrepancies in access times between better-off and poorer areas. CONCLUSION: Poorer areas experience worse geographical access to EMS and hospital emergency units. More research is needed to explore the quality of services and their outcomes, and to refine the analysis by focusing on specific vulnerable groups.

Geographical accessibility to community pharmacies by the elderly in metropolitan Lisbon.

BACKGROUND: In ageing societies, community pharmacies play an important role in delivering medicines, responsible advising, and other targeted services. Elderly people are among their main consumers, as they use more prescription drugs, need more specific health care, and experience more mobility issues than other age groups. This makes geographical accessibility a relevant concern for them. OBJECTIVES: To measure geographical pedestrian accessibility to community pharmacies by elderly people in the Lisbon Metropolitan Area (LMA). METHODS: The number of elderly people living within a 10- and 15-min walk was estimated based on the exploitation of population census data, the address-based location of 801 community pharmacies, and a Google Maps Application Programming Interface (API) method for calculating distances between pharmacies and the centroids of census statistical subsections. Results were compared to figures attained via traditional methods. RESULTS: In the LMA, 61.2% of the elderly live less than a 10 min walk from the nearest pharmacy and 76.9% live less than 15 min away. This opposes the common view that pharmacies are highly accessible in urban areas. In addition, results show a high spatial variability of proximity to pharmacies. CONCLUSIONS: Despite the illusion of good coverage suggested at the metropolitan scale, accessibility measures demonstrate the existence of pharmaceutical deprivation areas for the elderly. The findings indicate the need for more accuracy in both access measurements and redistribution policies. Measurement methods and population targets should be reconsidered.