Older people as active agents in their neighbourhood environments: Moving house can improve quality of life

Developing an indicator for community-level age-friendly communities: the Japan gerontological evaluation study

BACKGROUND

Age-friendly communities (AFCs) aim to create inclusive societies for older adults. The World Health Organization (WHO) highlights dementia considerations in AFC development; however, few community-level indicators include these elements. This study aimed to develop a community-level AFC indicator incorporating dementia-friendly elements based on WHO guidelines and to test its validity and reliability.

METHODS

A repeated cross-sectional design used data from the 2016 and 2019 waves of the Japan Gerontological Evaluation Study (JAGES) covering 61 school districts in 16 municipalities (45,162 individuals aged 65 and older in 2016 and 39,313 in 2019). The 2016 and 2019 datasets served as the development and retest samples, respectively. The item selection process involved extracting indicators from the JAGES survey items that aligned with WHO guidelines as well as those based on prior research on dementia-friendly communities (DFCs). Following expert consultations, 23 candidate items were identified. Data were aggregated at the school district level. Exploratory factor analysis (EFA) was conducted on the 2016 data to derive the factor structure, and confirmatory factor analysis (CFA) was used to assess model fit. The reproducibility of the factor structure was evaluated using EFA on the 2019 retest sample. Internal consistency and test-retest reliability were assessed.

RESULTS

The final 17-item indicator comprised three subscales: Social inclusion and dementia-friendliness (7 items, α = 0.86; e.g., Sense of belonging to the community), Social engagement and communication (5 items, α = 0.78; e.g., Participation in hobby groups), and Age-friendly physical environment (5 items, α = 0.82; e.g., Accessibility of barrier-free streets). The CFA showed an unsatisfactory model fit; however, test-retest reliability was adequate (r = 0.71-0.79; ICC = 0.67-0.78).

CONCLUSIONS

A valid and reliable 17-item community-level indicator was developed, aligning with the WHO framework and incorporating dementia-friendly elements. This indicator is a valuable tool for monitoring, evaluation, and inter-community comparisons, aiding the development of AFCs and DFCs in aging societies like Japan. Additionally, this indicator can be adapted for other high-income countries with similar socioeconomic backgrounds, healthcare systems, and community structures, providing a useful tool for age- and dementia-friendly initiatives.

CLINICAL TRIAL NUMBER

Not applicable.

The Association between Frailty, Quality of Life and Resilience in Community-dwelling Retirement Village Residents

OBJECTIVES

Housing quality has significant impact on the wider determinants of health and quality of life (QoL). Retirement villages are considered age-friendly accommodation for community-dwelling older people, offering a variable range of services and supports. We wished to explore the relationship among frailty, QoL, and resilience in older people residing in retirement villages.

DESIGN

Cross-sectional analysis within a longitudinal study.

SETTING AND PARTICIPANTS

Residents from 33 retirement villages in Auckland, Aotearoa, New Zealand.

METHODS

Frailty [using an interRAI-Community Health Assessment-based frailty index FI)], QoL [World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) and WHOQOL-Older Adults Module (WHOQOL-OLD)], and resilience [Brief Resilience Scale (BRS)]. Associations among frailty, QoL, and resilience were examined using regression analysis adjusting for confounders.

RESULTS

Mean (SD): FI 0.2 (0.1) in 479 residents, BRS 3.7 (0.8) in 395 residents, WHOQOL-OLD total score 69.9 (12.2). FI was inversely related to BRS [adjusted mean difference (MD) -0.35; 95% CI -0.43 to -0.26; P < .001] and WHOQOL-OLD (MD, -5.45; 95% CI -6.89 to 4.01; P < .001). FI inverse relationship was seen across all facets of WHOQOL-OLD and all WHOQOL-BREF facets except psychological.

CONCLUSIONS AND IMPLICATIONS

Frailty was inversely related to resilience and multiple domains of QoL in those living in presumed age-friendly and relatively resource-rich environments. Studies exploring causal relationships between these facets could inform interventions necessary to improve QoL and resilience in those living with frailty. Specific multidimensional needs, wishes, and concerns of older people living with frailty needs to be explored in order to potentially intervene on frailty, QoL, and resilience.

The Impact of Later Life Events on Cessation Motivation of Older Adults with Substance Use Disorder in Hong Kong

Life-course researchers have found that age-graded life events, such as marriage and employment, may provoke a turning point in the trajectories of substance use and motivate young adults with substance use disorder (SUD) to seek addiction treatment and cease illegal drug use. However, few studies have focused on the impact of the life events experienced by older adults with SUD in their later life on these trajectories. Even less is known about this phenomenon in non-Western contexts. Thus, we conducted interviews with 34 older individuals with SUD in Hong Kong and explored how later life events affected their motivation to cease illegal drug use. Our findings highlight the influence of age on how life events are experienced and the need for age-specific academic studies of substance use trajectories. The results also have implications for policymakers, as the criminalization and stigmatization of drug use may have a negative impact on the trajectories of substance use among older populations.