The Contribution of Sense of Community to the Association Between Age-Friendly Built Environment and Health in a High-Density City: A Cross-Sectional Study of Middle-Aged and Older Adults in Hong Kong

Examining dynamic developmental trends: the interrelationship between age-friendly environments and healthy aging in the Chinese population-evidence from China Health and Retirement Longitudinal Study, 2011-2018

BACKGROUND

The objective of this research is to investigate the dynamic developmental trends between Age-Friendly Environments (AFE) and healthy aging in the Chinese population.

METHODS

This study focused on a sample of 11,770 participants from the CHARLS and utilized the ATHLOS Healthy Aging Index to assess the level of healthy aging among the Chinese population. Linear mixed model (LMM) was used to explore the relationship between AFE and healthy aging. Furthermore, a cross-lagged panel model (CLPM) and a random-intercept cross-lagged panel model (RI-CLPM) were used to examine the dynamic developmental trends of healthy aging, taking into account both Between-Person effects and Within-Person effects.

RESULTS

The results from LMM showed a positive correlation between AFE and healthy aging (β = 0.087, p < 0.001). There was a positive interaction between the geographic distribution and AFE (central region * AFE: β = 0.031, p = 0.038; eastern region * AFE: β = 0.048, p = 0.003). In CLPM and RI-CLPM, the positive effect of healthy aging on AFE is a type of Between-Person effects (β ranges from 0.147 to 0.159, p < 0.001), while the positive effect of AFE on healthy aging is Within-Person effects (β ranges from 0.021 to 0.024, p = 0.004).

CONCLUSION

Firstly, individuals with high levels of healthy aging are more inclined to actively participate in the development of appropriate AFE compared to those with low levels of healthy aging. Furthermore, by encouraging and guiding individuals to engage in activities that contribute to building appropriate AFE, can elevate their AFE levels beyond the previous average level, thereby improving their future healthy aging levels. Lastly, addressing vulnerable groups by reducing disparities and meeting their health needs effectively is crucial for fostering healthy aging in these populations.

Optimization strategy of community planning for environmental health and public health in smart city under multi-objectives

As population density increases, environmental hygiene and public health become increasingly severe. As the space where residents stay for the longest time and have the most profound impact on their physical and mental health, the quality of the environment in urban communities largely determines the degree to which residents engage in physical activity, bear the risk of pollution exposure, and obtain healthy food. Therefore, in order to ensure the physical and mental health of residents, this study proposes community planning guided by environmental hygiene and public health, and establishes an environmental health assessment system for this purpose. This system evaluates the community environment from four aspects: land use, service facilities, site convenience, and environmental quality. Established the diversity, density, road network connectivity and facilities accessibility nine criteria, as well as the land function of mix, plot ratio, food environment, network ring α and connected β index, pavement risk level, green configuration and neighborhood material environment disorder degree of 27 indicators of community built environmental evaluation index system. The data is collected through field survey, questionnaire distribution, resident interview and data mapping, and the established evaluation index system is used to evaluate the construction environment of the community. The experimental research data included population data, CAD plan, land use data, street data, POI point data, building data and bus station data, etc. 273 questionnaires were distributed, 264 were recovered, 8 invalid questionnaires were removed, and 256 valid questionnaires were obtained. These experiments confirm that land use, service facilities, site convenience, and environmental quality have a significant impact on the built environment of communities, with impact weights of 0.513, 0.227, 0.135, and 0.125, respectively. The above weights are calculated based on the index judgment matrix and the eigenvectors. The scores of land use, service facilities, site convenience, and environmental quality for the study subjects were 3.44, 1.46, 0.94, and 0.51, respectively, among them, the land use score is less than 3.85, the 1 service facility score is less than 1.71, the site convenience score is less than 1.01, and the environmental quality score is less than 0.94; indicating that the community has serious problems such as single land use types, pollution exposure, and difficulty in obtaining healthy food. Therefore, community planning and transformation based on land use, service facilities, venue convenience, and environmental quality can effectively improve the physical and mental health of residents. In the specific community transformation plan, artificial intelligence and data-driven methods can be used to optimize the land use plan, service facility configuration, site convenience transformation and environmental quality improvement, so as to formulate the optimal community transformation plan and improve the comfort and happiness of community residents. In the future, on the basis of the existing research, the selection of community types will be further enriched and the research cases will be expanded. And through the in-depth practical study of the case, the constructed evaluation index system is optimized and improved to make it more scientific. At the same time, as urban renewal and design have entered the era of stock planning, based on the more perfect evaluation index system, more specific and detailed system discussion of the built communities with public health problems, in order to provide more detailed services for the construction of a better and healthy living environment in the future.

Analysis of the Impact of Environmental Perception on the Health Status of Middle-Aged and Older Adults: A Study Based on CFPS 2020 Data

Health risks and hazards caused by the environment have long been one of the most important public issues of concern to the state, society, and the public. At the same time, population aging is becoming a global issue, and residents' health is the most important component of people's livelihood, and residents can only pursue other rights and interests if they can protect their own health. Therefore, based on the micro data from the fifth round of the China Family Panel Studies (CFPS), this paper uses binary logistic regression with propensity score matching (PSM) to analyze the effect of environmental perception on the health status (including mental health and physical health) of middle-aged and older adults. It was found that environmental perceptions significantly affect the depressive state and sickness status of middle-aged and older adults. Among them, middle-aged and older adults who were female, of rural households, with low education and relatively low income were more affected by environmental shocks on their health. Therefore, we should pay attention to the mental and physical health of middle-aged and older adults and change the existing design concept of aging policy: the government should formulate effective policies and increase corresponding social support; and society and families should also give corresponding care and encourage middle-aged and older adults to exercise more and provide reasonable psychological guidance.

Co-creating inclusive spaces and places: Towards an intergenerational and age-friendly living ecosystem

Introduction

Evolving aging societies, ongoing digitalisation and circumstances of COVID-19 are changing living conditions for growing older. There is an increased urgency to view public health with a focus on integrating people of all ages into the matrix of opportunities afforded in their communities. This study initiates the conceptualization of an intergenerational, age-friendly living ecosystem (AFLE) to enhance public health planning.

Methodology

A participatory study was conducted using a multi-methods approach. Six virtual co-creation sessions (n = 35-50 participants), alongside a mainly open-ended INTERGEN survey designed specifically for this study (n = 130) were conducted to conceptualize multilevel ideas for building intergenerational age-friendly places using Bronfenbrenner's ecological systems model. At the height of COVID-19, virtual applications (Zoom, Moodboard) and case studies, creative methods (drawing, photography, storytelling and spotlight sessions) were applied to engage academic and non-academic participants between ages 5 - 80+ years, across eight countries. Sessions were video-recorded with visual themes captured by a graphic facilitator. The survey covered issues of multigenerational interactions; intergenerational and age-friendly place features; place safety; and necessary stakeholders required for creating intergenerational and age-friendly places. Data were reflexively analyzed using a team approach to thematic analysis.

Results

Findings present both the thematic analysis of Virtual Co-creation Camps (VCCs) and the INTERGEN survey results. These findings are addressed in three overarching categories that highlight the necessary characteristics of AFLEs as suggested by the VCC participants and survey respondents: (i) Sensory factors: feeling and emotion as starting points for physical design; (ii) Physical and digital factors in designing AFLE spaces and places; and (iii) Socio-cultural factors: tackling ageism and exclusion as part of the solution.

Discussion

The analysis resulted in a pathway toward enhanced understandings on how multi-generations can better interact with fluctuating organizational domains (industry, voluntary, academic and public sectors) in urban and rural settings to facilitate intergenerational connectivity. Through processes of co-creation, an AFLE proof of concept and roadmap for public health planning was developed to support and provide opportunities for people as they age to reap the socioeconomic benefits of their local and virtual communities and help them become well integrated, valued and contributory members of society.

Unequal impact of the COVID-19 pandemic on mental health: Role of the neighborhood environment

The COVID-19 pandemic has taken a significant toll on people's mental wellbeing. Few studies have investigated how the neighborhood environment might help to moderate the mental health impact in a natural disaster context. We aim to investigate the unequal impact of the pandemic on mental health between different population groups, and the role of the neighborhood environment in alleviating this impact. We collected survey data (n=2,741) on mental health, neighborhood environment, and pandemic-related behaviors in Beijing metropolitan region between July 10 and 28, 2020, and then applied the partial proportional odds model. Overall, we found that the pandemic has disproportionately affected the lower-income people. The lower-income residents experienced a greater psychological impact than the higher-income residents. We further found that distance to an urban park was a key built environment variable that moderates mental health impact. Residents who lived near urban parks were 4.2 to 4.6% less likely to report an increase in negative emotions, and therefore are more resilient to the mental health impact. In addition to the built environment, a cohesive neighborhood environment may have also helped to mitigate the negative mental health impacts. These findings can inform planning policies that aim to promote healthy and resilient communities.

A Meta-Analysis on the Influence of Age-Friendly Environments on Older Adults' Physical and Mental Well-Being

The importance of age-friendly environments (AFEs) for older adults has been empirically and theoretically highlighted by the extant literature. However, the strength of the association between environments and older adults’ well-being has not been comprehensively quantified. Given the different attributes of the physical and mental dimensions, this meta-analysis aims to synthesise and quantify the association between AFEs and the physical and mental well-being of older adults. Fourteen eligible studies were included in this analysis: among which eight explored the link between AFEs and physical well-being, and eleven investigated AFEs in association with mental well-being. A random-effects model showed a small but significant correlation between AFEs and the mental well-being of older adults (r = 0.160, 95% CI [0.084, 0.224], p < 0.001), and the correlation between AFEs and physical well-being was also significant (r = 0.072, 95% CI [0.026, 0.118], p < 0.01). The number of environmental factors involved in AFEs moderated the association with physical well-being, from which the association was only significant among studies focusing on fewer environmental factors (n < 6). Results of this meta-analysis indicated that AFEs may be more effective in promoting the emotions of older adults, compared to ameliorating their physical functioning. The limitations of current empirical studies and directions for future research in the field of environmental gerontology were also discussed.

Age-Friendly Communities and Older Adults’ Health in the United States

As age-friendly community (AFC) initiatives grow, it will be essential to determine whether older adults who live in an AFC have better health than those who live in other environments. This study uses data from the 2017 AARP AFC Surveys and the AARP Livability Index to assess whether AFCs promote the health of older adults. We analyze data for 3027 adults aged 65 and older who reside in 262 zip code areas. Following AARP guidelines, we allocated the sample into two groups: an AFC group (livability score of 51+; n = 2364) and a non-AFC (score ≤ 50, n = 663). The outcome variable was self-rated health (M = 3.5; SD = 1.1; range: 1–5). We used an inverse probability weighting approach to evaluate whether older adults who live in an AFC reported better self-rated health than those who live in a non-AFC. Findings showed that older adults who lived in an AFC had better self-rated health than those in a non-AFC (b = 0.08, p = 0.027). Compared to non-Hispanic Whites, Black and Hispanic older adults reported worse self-rated health. Inasmuch as living in an AFC can promote the well-being of older adults, policymakers and practitioners should continue to develop and sustain high-quality, accessible built and social environments.

A Scoping Review of Psychological Sense of Community among Community-Dwelling Older Adults

Psychological sense of community (PSOC) is an important construct for health and well-being outcomes for community-dwelling older adults. Drawing on the Ecological Theory of Aging and the Age-Friendly Cities (AFC) framework, this scoping review explored how PSOC has been used in research with community-dwelling older adults. This study examined antecedents, correlates, and outcomes of PSOC, with a focus on relevance to theory and practice. Databases were searched between 1986 and 2021 for peer-reviewed journal articles. Searches identified 582 unique articles, and 28 were included in the final sample. Three primary themes emerged in the synthesis: relevance to the AFC framework, PSOC as a predictor of health and well-being outcomes, and the role of PSOC in relocation. Findings from this review show that PSOC serves as a mechanism that links the social and physical AFC environments with health and well-being outcomes. This review also presents mechanisms for how features of the environment relate to PSOC. These findings demonstrate the role of PSOC as a resource to improve person–environment fit. Results from this review can be used to guide future research and inform theory, policy, and practice.

Perceived Community Age-friendliness is Associated With Quality of Life Among Older Adults

We examined the positive association between perceived community age-friendliness and self-reported quality of life for older adults. A total of 171 participants, aged 77–96 years, completed a mail-in questionnaire package that included measures of health (SF-36 Physical), social participation (Social Participation Scale), community age-friendliness (Age-Friendly Survey [AFS]), and quality of life (WHO Quality of Life). Hierarchical regression models including age, gender, driving status, finances, health, social participation, and AFS scores explained 8 to 21 per cent of the variance in quality of life scores. Community age-friendliness was a statistically significant variable in all models, accounting for three to six and a half per cent of additional variance in quality of life scores. Although the proportion of variance explained by age-friendliness was small, our findings suggest that it is worthwhile to further investigate whether focused, age-friendly policies, interventions, and communities could play a role towards successful and healthy aging.

The Moderating Role of Community Capacity for Age-friendly Communication in Mitigating Anxiety of Older Adults During the COVID-19 Infodemic: Cross-sectional Survey

Background

Older adults were perceived as a vulnerable group during the COVID-19 pandemic due to the health and mental health challenges they faced. The pandemic was accompanied by an “infodemic” of overabundant and questionable information that has affected older adults’ mental health. As the infodemic and ageist narratives were prevalent online, more anxiety symptoms have been induced among older adults who used social media. Age-friendly communication, advocated by the World Health Organization’s Age-friendly City (AFC) guide, could be an antidote by providing tailored information via appropriate channels for older adults.

Objective

This study investigated the role of community capacity for age-friendly communication in mitigating anxiety during the pandemic. We hypothesized that age-friendly communication would moderate the effects of infection risks and social media use on anxiety. A double-moderating effect was hypothesized in the context of diminished trust in traditional media.

Methods

Data were collected from a cross-sectional telephone survey conducted in Hong Kong in 2020. Older adults (N=3421, age≥60 years) were interviewed about their well-being and daily lives. Community capacity for age-friendly communication was measured in a living district–based evaluation. It had 2 components: the reach of appropriate information to older adults (AFC-Information) and the age-friendliness of communication technologies (AFC-Communication Technology) in the community. We tested the hypothesized moderation and double-moderation effects with ordinary least squares regressions.

Results

Perceived COVID-19 infection risk (b=0.002, P=.02) and use of social media for COVID-19 information (b=0.08, P=.04) were associated with more anxiety symptoms. The effect of using social media was moderated by AFC-Information (b=–0.39, P=.002) and AFC-Communication Technology (b=–1.06, P<.001), and the effect of perceived COVID-19 infection risk was moderated by AFC-Information (b=–0.03, P=.002) and AFC-Communication Technology (b=–0.05, P<.001). Lower trust in traditional media exacerbated anxiety symptoms associated with social media use (b=–0.08, P=.02). Higher AFC-Information alleviated this moderation effect (AFC-Information × media trust b=–0.65, P<.001; AFC-Information × social media use b=–2.18, P<.001; 3-way interaction b=0.40, P=.003).

Conclusions

Our findings highlight the role of community age-friendly communication in mitigating anxiety related to the infodemic. Although using social media may have exacerbated the impact of the infodemic on older adults, it has the potential to deliver timely information for an adequate health response. Although the amplifying effects of low media trust was associated with social media use, age-friendly communication determined its strength. Instead of discouraging the use of digital technologies for COVID-19 information, efforts should be made in tailoring information and communication technologies in local communities for older adults.

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.