Giving, Receiving, and Doing Together: Interorganizational Interactions in Age-Friendly Community Initiatives

Understanding the Institutional Logics of China's Community-Based Intervention for Older People

Community-based policies have gained global popularity, signaling a paradigm shift from individual responsibility for healthy aging to an approach involving community-based intervention. Learning from Western experience, China has also experimented with this form of intervention. It has policy interventions aimed at providing community-based facilities and services that enable older people to age in place. However, the institutional foundations of Chinese communities differ greatly from those in Western countries. Implementing a critical realist case study focusing on a community-based program in Beijing, this study aims to examine the institutional logics that contribute toward a contextually appropriate community-based policy intervention in China. We identified three institutional logics. First, the Confucian moral obligation of benevolence requires authorities to provide social welfare for vulnerable citizens. Second, China's community-based interventions are state-led territorialized provisions prioritizing communities rather than individuals. Third, community-based social policies are subordinate to economic growth objectives. This study contributes to the understanding of contextually appropriate community-based policy interventions in China.

Cross-Agency Collaboration to Address Rural Aging: The Role of County Government

Age-friendly community planning and design mainly focus on urban aging and may be less applicable in rural communities. We collaborated with the Tompkins County Age-Friendly Center for Excellence in New York State to assess strategies for rural aging. This commentary argues that density and mixed-use development, as age-friendly development strategies, leave rural communities underserved. County governments, by supporting cross-agency collaboration and encouraging civic engagement, can link the age-friendly domains regarding built environment, service delivery, and community together to help address age-friendly issues and support rural aging.

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.

Variation in Implementing Dementia-Friendly Community Initiatives: Advancing Theory for Social Change

Dementia-friendly communities (DFC) have emerged as a global movement to make communities more supportive and inclusive of people living with dementia (PLWD) and their care partners. This study contributes to a nascent body of research on DFC initiatives by building theory on their local implementation. Based on an analysis of data from semi-structured interviews with 23 leaders of initiatives in Massachusetts (United States), we aimed to identify key dimensions of variation in the implementation of DFC initiatives. We found that all initiatives engaged in a common set of activities, such as the facilitation of training about dementia and improving services for PLWD. Although initiatives mostly engaged in these activities in ways that targeted the community at large, in some instances, they concentrated their efforts on enhancing the dementia-friendliness of their own organizations. We describe ways in which financial, social, and human capital operate as key factors that influence the initiatives' primary focus (i.e., the community at large or their own organization). Our findings suggest the importance of helping DFC initiative leaders more explicitly specify the focal ecological level of their efforts throughout the trajectory of their work, especially in the context of resource considerations. Results also indicate ways in which DFC initiative efforts at one systems level can support those at other levels over time.

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.

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.

Age-Friendly Cities and Communities: Research to Strengthen Policy and Practice

Since the early 2000s, a global age-friendly movement has emerged with aspirations to make environments and systems within localities more supportive of long and healthy lives. Despite growth in the social movement over the past decade, research on how to work toward community change, especially in systematic and comprehensive ways across diverse geo-political and sociocultural contexts, has been relatively slower to develop. This special issue of the Journal of Aging & Social Policy aims to accelerate this area. It features articles that advance knowledge on processes and contexts toward enhancing the age-friendliness of cities and communities. In this introductory essay, we provide background on the age-friendly cities and communities movement - including its accomplishments alongside key challenges. We then discuss the importance of research at the intersection of policy and practice to strengthen the movement into the 21st century. Next, we introduce the articles in this special issue, organized under four themes: implementation and sustainability processes; partnerships and multisectoral collaboration; theory-based program design; and policy and practice diffusion. A final article provides an overview of the career contributions of Dr. Frank Caro, an age-friendly champion and gerontologist to whom this special issue is dedicated.