Neighbourhood vitality and physical activity among the elderly: The role of walkable environments on active ageing in Barcelona, Spain

Aging towards walkable futures: insights from a multidisciplinary workshop held in Barcelona, Spain

BACKGROUND

The aging of the world's population and the increase in sedentary lifestyles are leading to an increase in walking impairments at older ages. Here, we aimed to comprehensively discuss walking in the context of an aging population; and identify and agree on a list of future research priorities and policy actions.

METHODS

We followed a participatory approach and held a multidisciplinary two-day workshop on October, 2023 in Barcelona, Spain, with experts in the fields of aging and walking, and participants from the general public.

RESULTS

A total of 56 national and international participants, from a multidisciplinary background, joined the workshop. They had a median age of 40 years (range 24-83), and 62% were female. Participants discussed the meaning of walking from different perspectives and its change with age and in the presence of diverse mobility-impairing conditions; the emotional and social components of walking; and the role of the environment in walking. Participants identified unmet needs, research priorities and policy actions related to walking in older ages.

CONCLUSIONS

This two-day workshop provided a space for professionals and public to comprehensively discuss walking at older ages. Participants highlighted the relevance of a better and more comprehensive assessment of walking; the need to shift focus towards comprehensive health that considers physical, emotional and social aspects as well as individuals' preferences and expectations; and the importance of translating research into action. Future work can draw on the discussions held during this event in a thought-provoking and hypothesis-generating way.

Estimating exercisality on urban trails using physical exercise trajectory data and network-constrained approach

Green exercise is a key aspect of urban vitality, supporting the hypothesis that increased physical exercise boosts urban vitality. Although research on urban vitality considers green space a crucial aspect, existing studies have concentrated on external functioning from the perspective of special systems, often overlooking the unique internal functioning associated with exercisers. This study proposed an original conceptual framework of exercisality, which is composed of four dimensions: density, diversity, time continuity and energy expenditure. Considering urban trails are publicly accessible and linear-type green infrastructure for residents to conduct and maintain regular and habitual green exercise, we have developed an innovative quantitative approach to estimate and validate exercisality on urban trails (EUT), by utilizing physical exercise trajectory data from the Keep APP across central Beijing in 2022. The hot spots of EUT were identified through the innovative method of local indicators of network-constrained clusters. It is argued that this new index of EUT which is scale independence when applied to exercise trajectory big data, generates data driven evidence to support human well-being.

Spatiotemporal differences and influencing factors of urban vitality and urban expansion coupling coordination in the Pearl River Delta

In the contemporary state of accelerated urbanization in China, urban expansion has become the mainstream trend of urban development. However, in the context of urban expansion, whether coordinated development between urban expansion and urban vitality is achieved is an important concern facing the current urban expansion process. The Pearl River Delta (PRD) urban agglomeration is a hotspot of rapid economic development in China, and it is essential to examine the coupling relationship between the region's urban dynamics and urban expansion to promote rational urban development. This study analyzes the dynamics and evolutionary characteristics of urban expansion based on multisource nighttime light data, employing an UERI and other methods. We apply the entropy method and coupling coordination model to evaluate urban vitality and conduct a coupling analysis of urban expansion and urban vitality from 1992 to 2021. The results show that during the study period, the urban built-up area of the PRD urban agglomeration increased by 61,131.59 km2, urban vitality gradually increased each year, the coupling coordination between urban vitality and urban expansion gradually increased, and factors such as economic development, urban planning, and geographical location advantages also influenced changes in urban vitality and urban expansion and their coupling and coordination in the study area. This study provides a methodological reference and data support for the investigating the spatiotemporal evolution of urban agglomerations and urban vitality analysis.

Integrating street view images and deep learning to explore the association between human perceptions of the built environment and cardiovascular disease in older adults

Understanding how built environment attributes affect health remains important. While many studies have explored the objective characteristics of built environments that affect health outcomes, few have examined the role of human perceptions of built environments on physical health. Baidu Street View images and computer vision technological advances have helped researchers overcome the constraints of traditional methods of measuring human perceptions (e.g., these methods are laborious, time-consuming, and costly), allowing for large-scale measurements of human perceptions. This study estimated human perceptions of the built environment (e.g., beauty, boredom, depression, safety, vitality, and wealth) by adopting Baidu Street View images and deep learning algorithms. Negative binomial regression models were employed to analyze the relationship between human perceptions and cardiovascular disease in older adults (e.g., ischemic heart disease and cerebrovascular disease). The results indicated that wealth perception is negatively related to the risk of cardiovascular disease. However, depression and vitality perceptions are positively associated with the risk of cardiovascular disease. Furthermore, we found no relationship between beauty, boredom, safety perceptions, and the risk of cardiovascular disease. Our findings highlight the importance of human perceptions in the development of healthy city planning and facilitate a comprehensive understanding of the relationship between built environment characteristics and health outcomes in older adults. They also demonstrate that street view images have the potential to provide insights into this complicated issue, assisting in the formulation of refined interventions and health policies.

A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults

OBJECTIVE

To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes.

DATA SOURCES

PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021.

STUDY SECTION

Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted.

DATA EXTRACTION

The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted.

DATA SYNTHESIS

Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors.

CONCLUSIONS

Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.

[Encuesta Internacional de Indicadores de Salud Referidos por los Pacientes: el protocolo del Estudio PaRIS en España.]

OBJECTIVE

The PaRIS Survey is an initiative led by the Organization for Economic Cooperation and Development in twenty-one countries, including Spain, to promote people-centred health care. The objective of the study aimed to describe PROMS and PREMS (Patient Reported Outcomes and Experience Measures, respectively) from patients who were in contact with Primary Care Centres, in order to establish a set of reliable, valid and internationally comparable indicators.

METHODS

A cross-sectional study with two questionnaires will be carried out: one applied online for professionals from Primary Care Centres and another by telephone or online for patients aged forty-five and older of the same Health Care Centres. The domains covered are: characteristics of the Health Centre and of the professionals; sociodemographic characteristics of the patients; lifestyles; health care capacities; PROMs and PREMs.

CONCLUSIONS

The study offers a unique opportunity to evaluate the health outcomes and experiences of the care received in Primary Care from patient's perspective. This information is essential to help policymakers better understand the performance of their health system and how it could be improved, particularly in relation to chronic care in Primary Care.

Modeling Barcelona sidewalks: A high resolution urban scale assessment of the geometric attributes of the walkable network

Within the framework of urban pedestrian networks, this paper presents a method of modeling the street network from the perspective of foot traffic, beyond the vehicle-focused street centerline representation approach in transportation research. A scalable method to extract the centerlines of the complete walkable urban area from its polygon representation at a one-meter resolution is discussed, using open-source tools. To evaluate the betweenness centrality in a spatially directed graph, the process is applied to the study of the 'walkable Barcelona', focusing on three key parameters: 1) the street width, 2) the longitudinal slope, and 3) the crosswalks connecting the sidewalk platforms. The results identify the uneven distribution of these parameters within a complex urban fabric, and the high-resolution cartography allows the identification of critical areas within the network, introducing future lines of research and applications of the workflow. This is especially relevant considering the increasing awareness of citizens and the urban agendas worldwide, aimed at improving and widening the sidewalk infrastructure that supports local activity in cities.

Walk Score and Neighborhood Walkability: A Case Study of Daegu, South Korea

Walking is a popular physical activity that helps prevent obesity and cardiovascular diseases. The Walk Score, which measures neighborhood walkability, considers access to nine amenities using a geographic information system but does not deal with pedestrian perception. This study aims to (1) examine the correlation between access to each amenity, an individual component of the Walk Score, and perceived neighborhood walkability and (2) investigate the correlation with the perceived neighborhood walkability by adding variables of pedestrian perception to the existing Walk Score components. This study conducted a survey with 371 respondents in Daegu, South Korea, between 12 October and 8 November 2022. A multiple regression model was used to examine the correlations. The results showed no association between perceived neighborhood walkability and the individual component of the Walk Score. As variables of environmental perception, the fewer hills or stairs, the more alternative walking routes, the better separation between road and pedestrians, and the richer the green space, the more people perceived their neighborhood as walkable. This study found that the perception of the built environment had a more substantial influence on perceived neighborhood walkability than the accessibility to amenities. It proved that the Walk Score should include pedestrian perception and quantitative measurement.

Comparison of static and dynamic exposures to air pollution, noise, and greenness among seniors living in compact-city environments

GPS technology and tracking study designs have gained popularity as a tool to go beyond the limitations of static exposure assessments based on the subject's residence. These dynamic exposure assessment methods offer high potential upside in terms of accuracy but also disadvantages in terms of cost, sample sizes, and types of data generated. Because of that, with our study we aim to understand in which cases researchers need to use GPS-based methods to guarantee the necessary accuracy in exposure assessment. With a sample of 113 seniors living in Barcelona (Spain) we compare their estimated daily exposures to air pollution (PM2.5, PM10, NO2), noise (dB), and greenness (NDVI) using static and dynamic exposure assessment techniques. Results indicate that significant differences between static and dynamic exposure assessments are only present in selected exposures, and would thus suggest that static assessments using the place of residence would provide accurate-enough values across a number of exposures in the case of seniors. Our models for Barcelona's seniors suggest that dynamic exposure would only be required in the case of exposure to smaller particulate matter (PM2.5) and exposure to noise levels. The study signals to the need to consider both the mobility patterns and the built environment context when deciding between static or dynamic measures of exposure assessment.

A GBD 2019 study of health and Sustainable Development Goal gains and forecasts to 2030 in Spain

This study aimed to report mortality, risk factors, and burden of diseases in Spain. The Global Burden of Disease, Injuries, and Risk Factors 2019 estimates the burden due to 369 diseases, injuries, and impairments and 87 risk factors and risk factor combinations. Here, we detail the updated Spain 1990-2019 burden of disease estimates and project certain metrics up to 2030. In 2019, leading causes of death were ischaemic heart disease, stroke, chronic obstructive pulmonary disease, Alzheimer's disease, and lung cancer. Main causes of disability adjusted life years (DALYs) were ischaemic heart disease, diabetes, lung cancer, low back pain, and stroke. Leading DALYs risk factors included smoking, high body mass index, and high fasting plasma glucose. Spain scored 74/100 among all health-related Sustainable Development Goals (SDGs) indicators, ranking 20 of 195 countries and territories. We forecasted that by 2030, Spain would outpace Japan, the United States, and the European Union. Behavioural risk factors, such as smoking and poor diet, and environmental factors added a significant burden to the Spanish population's health in 2019. Monitoring these trends, particularly in light of COVID-19, is essential to prioritise interventions that will reduce the future burden of disease to meet population health and SDG commitments.

GPS-based activity space exposure to greenness and walkability is associated with increased accelerometer-based physical activity

INTRODUCTION

Built and natural environments may provide opportunities for physical activity. However, studies are limited by primarily using residential addresses to define exposure and self-report to measure physical activity. We quantified associations between global positioning systems (GPS)-based activity space measures of environmental exposure and accelerometer-based physical activity.

METHODS

Using a nationwide sample of working female adults (N = 354), we obtained seven days of GPS and accelerometry data. We created Daily Path Area activity spaces using GPS data and linked these activity spaces to spatial datasets on walkability (EPA Smart Location Database at the Census block group level) and greenness (satellite vegetation at 250 m resolution). We utilized generalized additive models to examine nonlinear associations between activity space exposures and accelerometer-derived physical activity outcomes adjusted for demographic characteristics, socioeconomic factors, and self-rated health.

RESULTS

Higher activity space walkability was associated with higher levels of moderate-vigorous physical activity, and higher activity space greenness was associated with greater numbers of steps per week. No strong relationships were observed for sedentary behavior or light physical activity. Highest levels of moderate-vigorous physical activity were observed for participants with both high walkability and high greenness in their activity spaces.

CONCLUSION

This study contributes evidence that higher levels of physical activity occur in environments with more dense, diverse, and well-connected built environments, and with higher amounts of vegetation. These data suggest that urban planners, landscape architects, and policy makers should implement and evaluate environmental interventions to encourage higher levels of physical activity.

Urban Vitality Evaluation and Spatial Correlation Research: A Case Study from Shanghai, China

Urban vitality is the primary driver of urban development. However, assessing urban vitality has always been a challenge. This paper builds on the research framework of sustainable development evaluation and selects evaluation indicators from the three systems of urban operation: economy, society, and environment. The deviation maximization (DM) method is used to evaluate urban vitality. Shanghai is then used as a case study for evaluation, and the comprehensive index of urban vitality is calculated for the city from 2010 to 2019. The evaluation results indicate that the urban vitality of Shanghai experienced a significant upward trend over ten years (2010–2019), which shows that the urban competitiveness of Shanghai is constantly strengthening. Next, the study focuses on the administrative region of Shanghai, to calculate the regional vitality level of Shanghai from 2010 to 2019 and to explore its spatial distribution characteristics. Then, a spatial autocorrelation analysis is used to explore the mechanism that affects the spatial distribution of urban vitality. The results demonstrate that the urban vitality in Shanghai shows a significant positive correlation in space. Moreover, there is a “High–High” gathering area, which includes Huangpu, Xuhui, Hongkou, and Changning in central area of Shanghai. This research provides a theoretical reference to support effective decision-making with respect to high-quality urban development.

Associations between cardiometabolic risks and physical activity in early adulthood: a cross-sectional study

OBJECTIVES

Young adults' physical activity (PA) is a foundation of creating future healthy lifestyles. The purpose of this study was to explore differences in PA, sedentary behaviour, walkability and health beliefs among young adults with different levels of cardiometabolic risks and the influence of moderate-to-vigorous PA.

DESIGN

A cross-sectional study was conducted using a structured questionnaire.

PARTICIPANTS

Totally, 1149 valid responses were received for a response rate of 86.32%. According to the self-reported worst health condition, participants were categorised into healthy adults, and adults at levels 1 (overweight), 2 (obese), 3 (hypertensive, hyperlipidaemic, and/or hyperglycaemic), and 4 (with a diagnosis of cardiometabolic diseases) of cardiometabolic risks.

PRIMARY OUTCOME MEASURES

PA, sedentary time, walkability and health beliefs.

RESULTS

Significant differences in PA (F=3.78, p<0.01) and sedentary time (F=2.39, p<0.05) among groups with various cardiometabolic risk levels were found. Healthy adults and adults at level 1 risk had significantly higher PA than adults at risk levels 2 and 3. Young adults at risk level 3 were less likely to participate in moderate-to-vigorous PA than were healthy adults (OR=0.64 (95% CI 0.41 to 0.99), p<0.05). Individuals who perceived that there were more recreational facilities (OR=1.27 (1.05 to 1.53), p<0.05), who had higher benefits of exercise (OR=1.73 (1.30 to 2.31), p<0.001), and who had lower barriers to exercise (OR=0.42 (0.32 to 0.55), p<0.001) were more likely to participate in moderate-to-vigorous PA.

CONCLUSIONS

Being aware of body weight changes could be a danger sign of a lack of PA. Developing environmental and psychological strategies to promote engaging in PA is necessary to promote the cardiometabolic health of young adults.

Environment-Stratified Age-Period-Cohort Effects on the Prevalence of Walking Among Older Adults

Walking promotes active aging; however, walking prevalence changes among older adults by age and environmental conditions remain unclear. Age-period-cohort (APC) differences in walking trends among Korean older adults were examined. Data included adults aged ≥ 65 years (n = 592,235) from the nationally representative Korean Community Health Survey. Regional units examined were metropolitan cities, small- and medium-sized cities, and rural areas. Environment-stratified APC modeling was applied for walking prevalence (walking days/time during the past week). From 2008 to 2017, the walking prevalence gap between regional units widened. Decreasing trends were most apparent in rural areas, including by birth year. In all areas, walking decreased with increased age. No distinct period effects were found. Each effect's magnitude was larger in rural areas than cities. Differential APC effects by environmental conditions likely influence walking prevalence changes among older adults. Walking promotion for older adults should consider APC effects and environmental conditions.

Safety perceptions of older adults on an urban greenway: Interplay of the social and built environment

BACKGROUND

Creating neighbourhood places for older adults to be socially and physically active is a global health priority. Safety is integral to older adult mobility. In greenway research, perceived safety is often only partially or superficially explored. Our study comprehensively examines older adults' experiences and perceived safety for walking on a new urban greenway in Vancouver, Canada-the Arbutus Greenway.

METHODS

We integrated mixed methods: i) observational count data to describe the use and context of the greenway over 3 years (2017; 2018; 2019), and; ii) semi-structured interviews with older adults at two time points (2017, n = 27; 2019, n = 16).

RESULTS

and discussion: We conducted thematic analysis to illuminate older adults' experiences across three safety domains: personal safety, traffic safety, and security. Built environment features such as benches, paving, road markings, and natural foliage buffers intersected with elements of the social environment to influence older adults' perceived safety. While the greenway supported active transportation, leisure, and social engagement for many older adults, certain factors also provoked fears, especially for older adults with mobility limitations. We advocate for a multidimensional lens to better understand how urban interventions influence perceived safety, and identify practical solutions to encourage mobility for all ages and abilities.

Integrating health indicators into urban and transport planning: A narrative literature review and participatory process

Today, urban and transport planners face considerable challenges in designing and retrofitting cities that are prepared for increasing urban populations, and their service and mobility needs. When it comes to health-promoting urban and transport developments, there is also a lack of standardized, quantitative indicators to guide the integration of health components right from the outset, i.e. in the formal planning or zoning phase. We narratively reviewed the literature and organized stakeholder workshops to identify and tailor planning principles and indicators that can be linked to health outcomes. We defined four core planning objectives that previous authoritative studies have suggested to result in positive health outcomes among city dwellers, which are: I) development of compact cities, II) reduction of private motorized transport, III) promotion of active (i.e. walking and cycling) and public transport, IV) development of green and public open space. Built on the review and stakeholder consensus, we identified 10 urban and transport planning principles that work towards achieving the four core objectives thought to provide health benefits for European city dwellers. These 10 planning principles are: 1) land use mix, 2) street connectivity, 3) density, 4) motorized transport reductions, 5) walking, 6) cycling, 7) public transport, 8) multi-modality, 9) green and public open space, and 10) integration of all planning principles. A set of indicators was developed and tailored for each planning principle. The final output of this work is a checklist ready to be applied by urban and transport professionals to integrate health into urban and transport developments in urban environments right from the outset.

Health-related quality of life of hospitalized COVID-19 survivors: An initial exploration in Nanning city, China

Understanding the health-related quality of life (HrQoL) of hospitalized COVID-19 survivors is an emerging global challenge arising from the current pandemic. A qualitative study of the experiences of sixteen hospitalized COVID-19 survivors from Nanning City, China, was conducted using semi-structured telephone interviews in May 2020. These first-hand accounts were critically and empirically analysed to identify emerging health and social issues, and provide potential solutions to improve survivors' quality of life. This in-depth, qualitative study of HrQoL for hospitalized COVID-19 survivors provides the first empirical evidence and conceptual framework with eight dimensions (physical symptoms, anxiety, trauma, economic loss, place-based identity, self-stigma, health self-interventions, and changing lifestyle) for understanding the physiological, psychological, socio-economic and health behavioral aspects of their daily lives. We argue that local and global governments should provide integrated healthcare, social and digital infrastructure to support this vulnerable group. More comparative and multi-disciplinary studies in this area are needed to generate academic standards of assessing health-related quality of life and produce good practice guidelines for promoting urban resilience in response to public health disasters.

Neighborhood walkability, physical activity and changes in glycemic markers in people with type 2 diabetes: The Hoorn Diabetes Care System cohort

Studies investigating neighborhood walkability and physical activity in people with type 2 diabetes (T2D) mainly used self-report measures, and only few studies assessed the association with glycemic control. This study assessed the associations between objectively measured (i.e. GIS based) and subjectively measured (i.e. questionnaire-based) neighborhood walkability and changes in glycemic markers in people with T2D, and whether this association was mediated by device-measured physical activity (PA), in the Diabetes Care System Cohort (n = 1230). Neither objective or subjectively measured walkability was associated with glycemic control. In mediation analyses we observed no overall mediation by PA.

Neighborhood Urban Design and Outdoor Later Life: An Objective Assessment of Out-of-Home Time and Physical Activity Among Older Adults in Barcelona

This study explores how older adults' time out-of-home and physical activity (PA) are associated with the provision of urban open spaces (green spaces, plazas, and boulevards) and microelements (street trees and benches) in their neighborhoods. The authors used data from 103 residents in Barcelona and matched it to official geospatial data. The authors adjusted a set of mixed-effects linear regressions, both for the entire sample and also stratified by age and gender. For the entire sample, the percentage of green spaces showed a positive association with neighborhood time out-of-home and PA, while participants' PA also showed a positive association with the presence of benches. Outdoor time among older women was not associated with any of the measured exposures. For men, the provision of green spaces and benches was positively associated with time out-of-home and PA. These results could inform the design of urban spaces that aim to encourage outdoor activity among older adults.

The effects of socioeconomic conditions on old-age mortality within shared disability pathways

Objective

How disability manifests itself in an individual is a highly complex process influenced by a wide range of individual and environmental factors. Its complexity makes the search for generalizable characteristics of the disablement process a challenging task. Consequentially, little is known about how the effect on other health outcomes such as life expectancy are modified after the onset of chronic ailments. In this paper we posit an alternative approach to generalize health trajectories of older people with disability and then analyze how socioeconomic conditions affect the longevity within these trajectory groups.

Methods

Individual level information about the first three successive onsets of chronic disability after age 50 is transformed into state-sequences. We extract trajectory groups based on onset time and the time spent in a certain state. Mortality hazards are then estimated with a Gompertz proportional hazards model to compare effects of different socioeconomic measures within the trajectory groups.

Results

Three distinct trajectory groups are identified, the mild (1), the early severe (2), and late severe (3) pathway. Estimates of the mortality analysis suggest that social inequalities in longevity are less pronounced after onset of old-age disability. We found a consistent survival prolonging effect for individuals who engage in daily activities (such as meeting with friends, walking) that ranged between 33.2% and 77.3%. The importance of other variables varies between trajectory groups.

Discussion

This study shows how health trajectories of individuals with disability can be generalized when information on the onset and severity of single conditions is available. Such an approach may help us to better predict health and care expenditures and help families and individuals with their personal care planning. The findings from the subsequent survival analysis suggest a substantial reduction of socioeconomic mortality differences after onset of old-age disability, which appears to be independent of its nature.

Factors associated with going outdoors frequently: a cross-sectional study among Swiss community-dwelling older adults

OBJECTIVE

This study examines potential risk and protective factors associated with going outdoors frequently among older persons, and whether these factors vary according to physical limitations.

DESIGN

Cross-sectional analysis.

SETTING AND PARTICIPANTS

Community-dwelling participants of the Lausanne cohort Lc65+ in 2016, aged 68-82 years (n=3419).

METHODS

Associations between going outdoors frequently and physical limitations, sociodemographic, health, psychological and social variables were examined using logistic regression models. Subgroup analyses were performed according to the severity of physical limitations.

MAIN OUTCOME MEASURES

'Going outdoors frequently' was defined as going out ≥5 days/week and not spending most of the time sitting or lying down.

RESULTS

Three in four (73.9%) participants reported going outdoors frequently. Limitations in climbing stairs (adjusted OR (AdjOR) 0.61, 95% CI 0.47 to 0.80) and walking (AdjOR 0.24, 95% CI 0.18 to 0.31), as well as depressive symptoms (AdjOR 0.58, 95% CI 0.47 to 0.70), dyspnoea (AdjOR 0.60, 95% CI 0.48 to 0.75), age (AdjORolder age group 0.73, 95% CI 0.59 to 0.92) and fear of falling (AdjOR 0.75, 95% CI 0.62 to 0.91) reduced the odds of going outdoors frequently. In contrast, living alone (AdjOR 1.30, 95% CI 1.08 to 1.56), reporting a dense (AdjOR 1.57, 95% CI 1.26 to 1.96) and a high-quality (AdjOR 1.28, 95% CI 1.06 to 1.53) social network increased the odds of going outdoors frequently. Among participants with severe limitations, 44.6% still went outdoors frequently. Among this subgroup, a new emotional relationship (AdjOR 2.52, 95% CI 1.18 to 5.38) was associated with going outdoors, whereas cognitive complaints (AdjOR 0.66, 95% CI 0.47 to 0.93), urinary incontinence (AdjOR 0.67, 95% CI 0.46 to 0.97), dyspnea (AdjOR:0.67, 95%CI:0.48-0.93), and depressive symptoms (AdjOR 0.67, 95% CI 0.48 to 0.93) lowered the odds of going outdoors.

CONCLUSION

Physical limitations are associated with decreased odds of going outdoors frequently. However, social characteristics appear to mitigate this association, even among older persons with severe limitations. Further studies are needed to determine causality and help guide interventions to promote going outdoors as an important component of active ageing.

Do Stairs Inhibit Seniors Who Live on Upper Floors From Going Out?

BACKGROUND

Walk-up buildings are common in China today since they were almost the only type of residential buildings constructed from the 1950s to the 1990s.

OBJECTIVES

This study examined how a vertical mobility obstacle, that is, mandatory stair climbing in walk-up residential buildings, may impact whether seniors go outdoors.

METHODS

We collected and examined 1,608 valid data records from 64 Chinese senior participants in Shanghai wearing Fitbit HR wristbands that tracked their mobility and physical activity for 31 consecutive days. Multilevel mixed-effects logistic regressions were performed on the binary leaving-home-or-not probability by the level of vertical obstacles controlled for physical-demographic factors, socioeconomic factors, outdoor activity habits, and weather.

RESULTS

Our observations revealed that each floor above ground level reduced the likelihood of outdoor trips by approximately one third per floor. After controlling for the physical, demographic, and socioeconomic factors of the participants as well as weather and holidays, we found that significantly fewer going-out incidents were also associated with more frequent outdoor activities within the community, especially in paved areas, but no associations were observed with self-reported visit frequencies to green spaces, senior centers within the community, or other places outside the community.

CONCLUSION

This study offered the in situ observation that seniors' probability of leaving their homes is correlated with the degree of vertical circulation as a mobility barrier (i.e., the number of stairs between their living space and access to the outdoors), which may impact policy making for regulations concerning elevators in residential codes and renovations.

Physical activity benefits of attending a senior center depend largely on age and gender: a study using GPS and accelerometry data

BACKGROUND

Senior centers offer important opportunities for physical activity and social interaction. Seniors who visit a senior center regularly can gain physical activity from transportation and from specific activities offered within the senior center. However, there is very little knowledge regarding the specific physical activity gains obtained from regular visits to senior centers, and no effort has been made to use device-based measures of physical activity to test the potential physical activity benefits of attending a senior center.

METHODS

To fill this gap, the present study examined the physical activity patterns of 227 seniors living in the Barcelona Metropolitan Area in Spain. Using GPS and Accelerometer 7-day tracking data, and GIS measures we assessed the light physical activity and moderate-to-vigorous intensity physical activity (MVPA) benefits of attending the senior center on a weekly and daily basis.

RESULTS

Seniors who attended a senior center at least once a week did not accumulate significantly more daily physical activity (211.6 min; 95% CI 196.6; 226.6) than seniors without any visit 215.9 min; 95% CI 202.7; 229). However, on a day-to-day basis, it was found that visiting a senior center had positive effects in physical activity and was associated with less sedentary time among younger participants in general (- 18.2 daily min 95% CI - 33.2;-3.3 p = 0.016) and among older female participants in particular (- 19.7 daily min 95% CI -21.06;-18.5 p = 0.011).

CONCLUSIONS

The benefits of attending senior centers in terms of physical activity should not be viewed as universal, but rather as contingent to the demographics of the user, and the type of activity that the visit is replacing.

The interrelationship between place and critical life transitions in later life social exclusion: A scoping review

Understanding the role of place in protecting against social exclusion (SE) and risk during critical life transitions (CLTs) in older age is essential to create effective community-level ageing policies. However, existing knowledge is diffuse across a range of literatures and lacks coherency. Through a two-stage scoping review, this paper aims to synthesise state-of-the-art international research linking place, old-age SE and CLTs. Findings show that: (1) place serves as a setting for, and as a mediator of exclusion resulting from CLTs and (2) theoretical conceptualisation to address the intersection of CLTs, place and SE in later life is underdeveloped. The implications of the state of scientific knowledge on this topic are discussed in relation to future research needs and ageing in place policy.

Spatial Explicit Assessment of Urban Vitality Using Multi-Source Data: A Case of Shanghai, China

Identifying urban vitality in large cities is critical for optimizing the urban fabric. While great attention has been paid to urban vitality in developed countries, related studies have been rarely conducted in developing countries. In this study, we defined urban vitality as the capacity of an urban built environment to boost lively social activities and developed a framework for measuring urban vitality using the dimensions of built environment, human activities, and human–environment interaction. Taking Shanghai, China as a case, we conducted a measurement of urban vitality using multi-source data. The results show that Shanghai follows a monocentric vital pattern within the outer ring road, with urban vitality declining from the central urban core to the city periphery. While the old urban cores tend to show high urban vitality, Pudong New Area is mostly dominated by low vitality. Three clusters with high urban vitality were identified: the old urban area, the Lujiazui CBD, and residential agglomeration areas. We conducted validation of the measuring results using phone usage density. Urban vitality showed a positive correlation with phone usage density, indicating a high accuracy of assessment. We also discovered that European-style block planning, zoning plan, mixed-functional development, urban renewal regulation, and migrant concentration were playing leading role in urban vitality of Shanghai.

Participant and Public Involvement in Refining a Peer-Volunteering Active Aging Intervention: Project ACE (Active, Connected, Engaged)

Background

Evidence for the health benefits of a physically active lifestyle among older adults is strong, yet only a small proportion of older people meet physical activity recommendations. A synthesis of evidence identified "best bet" approaches, and this study sought guidance from end-user representatives and stakeholders to refine one of these, a peer-volunteering active aging intervention.

Methods

Focus groups with 28 older adults and four professional volunteer managers were conducted. Semi-structured interviews were conducted with 9 older volunteers. Framework analysis was used to gauge participants' views on the ACE intervention.

Results

Motives for engaging in community groups and activities were almost entirely social. Barriers to participation were lack of someone to attend with, lack of confidence, fear of exclusion or "cliquiness" in established groups, bad weather, transport issues, inaccessibility of activities, ambivalence, and older adults being "set in their ways". Motives for volunteering included "something to do," avoiding loneliness, the need to feel needed, enjoyment, and altruism. Challenges included negative events between volunteer and recipient of volunteering support, childcare commitments, and high volunteering workload.

Conclusion

Peer-volunteering approaches have great potential for promotion of active aging. The systematic multistakeholder approach adopted in this study led to important refinements of the original ACE intervention. The findings provide guidance for active aging community initiatives highlighting the importance of effective recruitment strategies and of tackling major barriers including lack of motivation, confidence, and readiness to change; transport issues; security concerns and cost; activity availability; and lack of social support.

Social exclusion of older persons: a scoping review and conceptual framework

As a concept, social exclusion has considerable potential to explain and respond to disadvantage in later life. However, in the context of ageing populations, the construct remains ambiguous. A disjointed evidence-base, spread across disparate disciplines, compounds the challenge of developing a coherent understanding of exclusion in older age. This article addresses this research deficit by presenting the findings of a two-stage scoping review encompassing seven separate reviews of the international literature pertaining to old-age social exclusion. Stage one involved a review of conceptual frameworks on old-age exclusion, identifying conceptual understandings and key domains of later-life exclusion. Stage two involved scoping reviews on each domain (six in all). Stage one identified six conceptual frameworks on old-age exclusion and six common domains across these frameworks: neighbourhood and community; services, amenities and mobility; social relations; material and financial resources; socio-cultural aspects; and civic participation. International literature concentrated on the first four domains, but indicated a general lack of research knowledge and of theoretical development. Drawing on all seven scoping reviews and a knowledge synthesis, the article presents a new definition and conceptual framework relating to old-age exclusion.

Happiness and health across the lifespan in five major cities: The impact of place and government performance

RATIONALE

A growing body of research suggests that urban design has an effect on health and well-being. There have been very few studies to date, however, that compare these effects across the lifespan.

OBJECTIVE

The current study examines the direct and indirect effects of the city environment on happiness. It was hypothesised that citizens' ratings of their city along dimensions of performance (e.g., basic - usually government - services related to education, healthcare, social services, and policing) and place (e.g., the beauty of the city and a built environment that provides access to cultural, sport, park, transport, and shopping amenities) would be significant predictors of happiness but that the nature of these effects would change over the lifespan.

METHODS

5000 adults aged 25-85 years old living in Berlin, Paris, London, New York, and Toronto completed the Quality of Life Survey in 2007. Respondents reported their happiness levels and evaluated their city along place and performance dimensions.

RESULTS

The results of the study demonstrate an interesting, and complex relationship between the city environment and happiness of residents across the lifespan. Findings suggest that the happiness of younger residents is a function of having easy access to cultural, shopping, transport, parks and sport amenities and the attractiveness of their cities (i.e. place variables). The happiness of older residents is associated more with the provision of quality governmental services (i.e., performance variables). Place and performance variables also have an effect on health and social connections, which are strongly linked to happiness for all residents.

CONCLUSION

Younger adults' happiness is more strongly related to the accessibility of amenities that add to the quality of a city's cultural and place characteristics; older adults' happiness is more strongly related to the quality of services provided within a city that enable residents to age in place. These results indicate that, in order to be all things to all people, cities should emphasize quality services (e.g., good policing, schools, healthcare access), beauty and character, and provide easy access to transport amenities and cultural and recreational opportunities.

Neighbourhood environment and physical activity in older adults

RATIONALE

The neighbourhood socio-physical environment has effects on health in later life including health behaviours, chronic illnesses, mental health and mortality. Few studies have examined the relationship of both physical environmental features and social aspects of neighbourhood with older adults' physical activity.

OBJECTIVE

This study examined the relationship of neighbourhood physical and social environment with physical activity among older adults.

METHODS

A cross-sectional telephone survey was conducted with 434 older adults in eight neighbourhoods in greater Vancouver, Canada and Portland, United States. Data included participants' perceptions of their neighbourhood built and social environment factors and levels of physical activity. A logistic regression analysis was conducted to understand the relationship between these factors.

RESULTS

Participants engaged in physical activity most frequently at home (87.1%) or in close proximity of home (76.5%). Neighbourhood walkability, presence of amenities and accessibility were not significantly associated with meeting physical activity requirements. Participation in a recreational program with friends was associated with increased likelihood of physical activity.

CONCLUSION

The home and its immediate physical environmental context has potentially important relevance in supporting physical activity in older adults. Also, neighbourhood social aspects have a positive influence on activity levels.

Destinations That Older Adults Experience Within Their GPS Activity Spaces Relation to Objectively Measured Physical Activity

Identifying the relevant geography is an ongoing obstacle to effectively evaluate the influence of neighborhood built environment on physical activity. We characterized density and diversity of destinations that 77 older adults experienced within individually representative GPS activity spaces and traditional residential buffers and assessed their associations with accelerometry-measured physical activity. Traditional residential buffers had lower destination density and diversity than activity spaces. Activity spaces based only on pedestrian and bicycling trips had higher destination densities than all-mode activity spaces. Regardless of neighborhood definition, adjusted associations between destinations and physical activity generally failed to reach statistical significance. However, within pedestrian and bicycling-based activity spaces each additional destination type was associated with 243.3 more steps/day (95% confidence interval (CI) 36.0, 450.7). Traditional buffers may not accurately portray the geographic space or neighborhood resources experienced by older adults. Pedestrian and bicycling activity spaces elucidate the importance of destinations for facilitating active transportation.