Exploring rural older adult perspectives on the scope, reach and sustainability of age-friendly programs

"I'm Part of Something That Matters": Exploring What Older Adults Value Through Their Engagement in Age-Friendly Community Initiatives

Older adults' engagement in age-friendly community (AFC) initiatives is considered an essential element of community transformation. However, research on older adults' experiences of engaging in AFC initiatives remains nascent. Based on qualitative interviews with 23 older adult participants from 15 AFC initiatives across four states in the United States (U.S.), our reflexive thematic analysisidentified three themes regarding what participants value from their engagement: (a) social contribution; (b) social connectedness and integration; and (c) staying active and personal growth. Exploring older adults' interest in contributing to, connecting with, and growing in their community can inform recruitment and retention in AFC initiatives.

Divergent Experiences Reported by Rural and Frontier Older Adults Aging in Place

Aging research tends to define rural as any area that is not urban without considering the diversity that exists within rural environments. Using government guidelines defining frontier and rural counties, the purpose was to identify similarities and differences in the aging experience reported by community-dwelling rural and frontier older adults. Individual interviews were completed in Wyoming with 142 older adults from frontier (n = 72) and rural counties (n=70). Summative content analysis was used to evaluate responses within the framework of social influences and nested environmental interactions of a socio-ecological model. Rural older adults reported needing more medical services and care, while frontier adults indicated an absence for many of these services. Similar response patterns were indicated with regard to grocery stores and general shopping. Current interview statements provide foundational information for future policies that recognize frontier aging in place that does not equate to aging in rural specific areas.

The Built Environment and Social and Emotional Support among Rural Older Adults: The Case for Social Infrastructure and Attention to Ethnoracial Differences

Social and emotional support (SaES) is essential for older adult mental health and is shaped by individual-level factors and the built environment. However, much of the focus on the built environment, and specifically social infrastructure - the physical places that facilitate social interaction and social tie formation - relies heavily on urban settings or samples with limited diversity. Consequently, there is little understanding if social infrastructure matters for the SaES of older adults in rural America, and across race and ethnicity. Therefore, we use social cohesion as a conceptual lens and the community gerontology framework to determine if availability of social infrastructure is associated with SaES among older adults in rural America and if this relationship varies across race and ethnicity. Using data from 110,850 rural older adults from the Behavioral Risk Factors Surveillance System and data from the National Neighborhood Data Archive, we show that among rural ethnoracial minority older adults, higher densities of social infrastructure are associated with higher SaES. This is not true for rural non-Hispanic White older adults. Results highlight the importance of accounting for both social infrastructure as part of the built environment and heterogeneity across race and ethnicity in studies that examine older adult mental and emotional health.

Rural age-friendly ecosystems for older adults: An international scoping review with recommendations to support age-friendly communities

Background and Aims

The population of older adults in rural areas is rising, and they experience higher rates of poverty and chronic illness, have poorer health behaviors, and experience different challenges than those in urban areas. This scoping review seeks to (1) map the state of the science of age-friendly systems in rural areas regarding structural characteristics, processes for delivering age-friendly practices, and outcomes of age-friendly systems, (2) analyze strengths, weakness, opportunities, and threats of age-friendly system implementation, and (3) make person, practice, and policy-level recommendations to support active aging and development of age-friendly communities.

Methods

An international scoping review was conducted of articles that used age-friendly framing, had a sample age of 45 years of age or older, self-identified as rural, and reported empiric data. Searches were conducted in PubMed, CINAHL, AgeLine, PsychINFO, EMBASE, Scopus, and Academic Search Elite on October 26, 2021, and rerun March 10, 2023. Data were charted across three analytic layers: socioecological model, Donabedian's framework, and SWOT analysis.

Results

Results reveal limited data on outcomes relevant to organizations, such as return on investment or healthcare utilization. While the SWOT analysis revealed many strengths of age-friendly systems, including their impact on persons' outcomes, it also revealed several weaknesses, threats, and gaps. Namely, age-friendly systems have weaknesses due to reliance on trained volunteers and staff, communication, and teamwork. System-level threats include community and health system barriers, and challenges in poor/developing areas.

Conclusions

While age-friendly systems in this review were heterogeneous, there is an opportunity to focus on unifying elements including the World Health Organization age-friendly cities framework or 4Ms framework for age-friendly care. Despite the many benefits of age-friendly systems, we must acknowledge limitations of the evidence base, pursue opportunities to examine organizational metrics to support implementation and sustainability of age-friendly systems, and leverage improvements in age-friendliness at a community level.

Universities as Intermediary Organizations: Catalyzing the Construction of an Age-Friendly City in Hong Kong

Background and Objectives

The construction of an Age-Friendly City (AFC) requires active contribution from relevant interest groups including older adults, nonprofit organizations, and policy-makers. However, given that relevant interest groups may have limited resources, knowledge, and skills, as well as unique contextual factors, they often require help from intermediary organizations-actors that aim to build interest groups' capabilities. Our objectives were to examine the functions of universities, as an example of intermediary organizations, in facilitating the construction of an AFC, and identify critical factors that enable intermediary organizations to perform their functions.

Research Design and Methods

We conducted three focus groups and one individual interview with multiple interest groups including older adults and social workers from nonprofit organizations and local government involved in a 6-year citywide AFC project in Hong Kong. Participants were asked to share their views on the role of universities in relation to their own experiences and roles in the project. Data generated from the interviews were analyzed using thematic analysis.

Results

Four themes pertinent to the functions of universities in facilitating development were identified: facilitating cross-sector collaborations, knowledge diffusion, interest-group building, and mediating divergent interests. We also found that neutrality and reputability are key characteristics for intermediary organizations to wield sufficient legitimacy to perform their functions efficiently.

Discussion and Implications

Findings underscore the important yet overlooked role of intermediary organizations in bridging and mediating different interest groups to facilitate AFC development. We advance gerontological scholarship by providing insights into the theoretical mechanisms and practice implications for intermediary organizations in fostering an AFC.

Aligning Policy, Place and Public Value: Planning Age Friendly Cities in Municipal Organizations

KEY POINTS

Age-friendly planning should not fall to local departments of senior services only.Planning coordination of age-friendly policy results in more diverse outcomes.Mapping is a tool helping policy makers visualize alternative opportunities.Maps give stakeholders the ability to track and monitor progress.This approach is easily replicable for cities implementing age-friendly programs.

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.

Perceptions of community among suburban and urban-dwelling adults aging in place

Community is important for late-midlife adults, offering a sense of belonging and opportunities for social engagement during the transition to older age. The current study examines perceptions of community and geographical ties among a sample of older adults aging in place. Using data from the Foley Longitudinal Study of Adulthood (FLSA; N = 163; aged 61-64) and a qualitative GIS approach, major themes were categorized and mapped to create a comprehensive picture of how perceptions of community varied among respondents and neighborhoods. Core themes were connections to place, space, people, and relational benefits gained from community involvement. Residents of a suburban enclave more frequently noted connections to people as being important to community, compared to residents in more densely-populated areas. Implications for future research are discussed.

Exploring the sustainability of age-friendly initiatives in a Canadian province

BACKGROUND AND OBJECTIVES

Based on the WHO Age-friendly Cities and Communities (AFCC) framework, the government of Manitoba, Canada, launched a province-wide age-friendly initiative in 2008. The objective of this study was to explore the sustainability of the AFCC initiative more than a decade later. The study was guided by conceptualizations of sustainability as multi-dimensional and dynamic, composed of four aspects (continued capacity; institutionalization; continued benefits; and development/adaptation), and an ecologic perspective that highlights the importance of contextual influences, and their change over time, on AFCC activities.

RESEARCH DESIGN AND METHODS

The study involved a qualitative, multiple case study design. Semi-structured interviews were conducted in 2020 with a key informant from each of 52 AFCC. Interview data were analyzed deductively, guided by the sustainability framework and an ecologic perspective. Census data was used to describe the demographic characteristics of AFCC.

RESULTS

We identified six groups of AFCC initiatives that varied in degree from the most to the least sustainable: active; in hiatus; re-organized; stalled; discontinued; and never got off the ground. Both local, community factors (e.g., lack of capacity), and broader contextual factors, such as demographic changes and provincial legislations influenced initiatives' sustainability.

DISCUSSION AND IMPLICATIONS

AFCC initiatives can range in their degree of sustainability, and can wax or wane over time. On-going external support for AFCC (e.g., from provincial or state government) to promote the vision of age-friendliness, and to addresses lack of capacity (e.g., to assist with community assessments) could help with the long-term sustainability of initiatives.

Spillover benefits and achieving sustainability of age-friendly communities

As the age-friendly movement grows in its second decade, urgent questions of initiative sustainability have taken hold in the academic literature and among advocates implementing age-friendly changes. The creation of authentically age-inclusive environments requires not just the continuation of the initiative, but that its principles become embedded in formal and informal organizational processes, across sectors and beyond familiar networks focused on older populations. This embedding ensures the initiative's values take root permanently in a community's institutional culture. This paper argues that sustainability of age-friendly initiatives is enhanced by "spillover" effects, in which a behavioral or policy change in one environment spurs change in another environment. Evidence for such spillover and an understanding of how and when it occurs is currently limited in the context of age-friendly environments. This paper draws on the experiences of Age-Friendly Boston, which has been working towards age-friendly goals for more than five years. Based on Boston's experience, we identify, describe, and exemplify three pathways to positive spillover across environments: 1) branding positively; 2) publicizing successes; and 3) embarking on new relationships, while strengthening existing ones, in pursuit of shared goals. We also draw conclusions about what positive spillover means for the sustainability of age-friendly environments.

Beginning on an age-friendly journey: Barriers to implementing age-friendly initiatives

Objective

To explore the barriers to communities in New Zealand developing age‐friendly initiatives.

Methods

A qualitative participatory approach underpinned this study. Semi‐structured digitally recorded individual interviews were undertaken with 24 government officials, local government steering group members and community representatives from an urban city, provincial city and a rural district. A general inductive data analytic process was undertaken. The consolidated criteria for reporting qualitative research (COREQ) guidelines were followed to ensure rigour in this study.

Results

(a) Being at the beginning, (b) Minimal diversity and (c) Problems getting started were three key issues identified.

Conclusions

New Zealand is in the early stages of becoming age‐friendly. Findings from this study provide a place‐based New Zealand perspective and have influenced central government social policy and practice development, culminating in resources supporting local government and communities to successfully implement age‐friendly initiatives.