Age-Friendly Environments and Self-Rated Health: An Exploration of Detroit Elders

While a number of organizations and government entities have encouraged the development of more “age-friendly” environments, to date there has been limited research linking these environment features to elder outcomes. Using a representative sample of older adults living in Detroit, this study examined the association between age-friendly environment factors and self-rated health. Results indicated that access to health care, social support, and community engagement were each associated with better self-rated health, while neighborhood problems were associated with poorer self-rated health. Moreover, individual-level income and education no longer predicted self-rated health once age-friendly environment factors were taken into account. These findings highlight the need for more research documenting the effects of age-friendly environments, particularly across diverse contexts and populations

Do Age-Friendly Characteristics Influence the Expectation to Age in Place? A Comparison of Low-Income and Higher Income Detroit Elders

Currently there is limited evidence linking age-friendly characteristics to outcomes in elders. Using a representative sample of 1,376 adults aged 60 and older living in Detroit, this study examined the association between age-friendly social and physical environmental characteristics and the expectation to age in place, and the potential differences between low- and higher-income elders. Based on U.S. Environmental Protection Agency’s (EPA) age-friendly guide, we identified six factors reflecting age-friendly characteristics. Logistic regression models indicated that regardless of income level only neighborhood problems were significantly associated with expecting to age in place. Low-income elders were more likely to expect to age in place than their higher-income counterparts, and it is unclear whether this resulted from a desire to remain in the home or that there is no place else to go. Future research should address the ways in which financial resources affect the choices, expectations, and outcomes of aging in place

Conceptualizing age-friendly community characteristics in a sample of urban elders: An exploratory factor analysis

Accurate conceptualization and measurement of age-friendly community characteristics would help to reduce barriers to documenting the effects on elders of interventions to create such communities. This article contributes to the measurement of age-friendly communities through an exploratory factor analysis of items reflecting an existing U.S. Environmental Protection Agency policy framework. From a sample of urban elders (n =1,376), we identified six factors associated with demographic and health characteristics: Access to Business and Leisure, Social Interaction, Access to Health Care, Neighborhood Problems, Social Support, and Community Engagement. Future research should explore the effects of these factors across contexts and populations

Local Government Adoption of Aging-Friendly Policies and Programs: A Mixed Methods Approach

In recent years a growing number of international, national, state, and local initiatives have started working to make existing communities more aging friendly. This interest in changing the physical and social environment of existing communities to improve the health and well-being of older adults and help them age in place is a reaction to a confluence of factors, including the aging of the U.S. population, a projected increase in disability and chronic disease in future cohorts of older adults, and an inadequate long-term care system. Aging-friendly communities share three characteristics: 1) individuals can continue to pursue and enjoy interests and activities, 2) supports are available so that individuals with functional disabilities can still meet their basic health and social needs, and 3) older adults can develop new sources of fulfillment and engagement (Lehning, Chun, & Scharlach, 2007). Framed by an internal determinants and diffusion model, this study uses a sequential explanatory mixed methods research design to explore 1) the extent to which 101 cities in 9 counties in a geographically and economically diverse metropolitan area have adopted aging-friendly policies, programs, and infrastructure changes in the areas of community design, housing, transportation, health care and supportive services, and opportunities for community engagement, and 2) the diffusion factors, community characteristics, and government characteristics associated with such adoption. The researcher collected and analyzed quantitative and qualitative data from four types of respondents: city planners/community development directors, directors of county adult and aging services, county transportation authority employees, and public transit officials. In the quantitative phase, the researcher combined primary data collected via online surveys with secondary data from the 2000 U.S. Census and the 2000 California Cities Annual Report. In the qualitative phase, a subsample of 18 survey respondents participated in open-ended telephone interviews to provide a more in-depth understanding of the process of the adoption of aging-friendly innovations and expand on the quantitative findings. For the first research question, the most common aging-friendly innovations adopted by local governments include those that target alternative forms of mobility, including incentives for mixed use neighborhoods, infrastructure changes to improve walkability, discounted public transportation fares, and changes to improve accessibility of public transit. The least common policies and programs are those that aim to help older adults continue driving and those that provide incentives to develop accessible new housing for older adults. For the second research question, bivariate analyses of city-level data provide partial support for an internal determinants and diffusion model. Cities with a larger total population, larger percent of the population with a disability, and have experienced public pressure or individual advocacy for aging-friendly innovations adopted more aging-friendly policies, programs, and infrastructure changes. Contrary to hypotheses, cities with higher population educational attainment, higher median household income, and a larger proportion of the population age 65 and older adopted fewer aging-friendly innovations. Qualitative interviews offered potential explanations for these results. First, disability groups may be more active than older adults in terms of advocating for the adoption of certain aging-friendly innovations, such as accessible housing and walkable neighborhoods. Second, communities whose population enjoys a higher socioeconomic status may not perceive a strong role for local government in terms of creating more aging-friendly communities, and these residents may get their needs met through nongovernmental sources. Third, while there was no significant association between per capita government spending and the adoption of aging-friendly innovations, interviews suggest that funding plays an important role, and perhaps grant funding, slack resources, and recent increases or decreases in local government financial resources are a better measure of this factor. Finally, qualitative interviews indicate that future studies should explore additional factors, including communication, collaboration, and state and federal mandates. The findings of this study suggest a number of research and practice implications that should be further explored in future research. First, the results and limitations of this research suggest that it should be replicated to determine whether the findings explain local government adoption of aging-friendly innovations in general or are specific to the population and methods used in this study. This replication should not only expand the sample size and explore the generalizability of findings to other geographic regions, but use a modified internal determinants and diffusion model that takes into account findings of the present study. Second, given the limitations of the current study, results offer a number of strategies that residents, advocates, service providers, and policymakers could employ in their efforts to create more aging-friendly communities. These strategies include mobilizing public support of and pressure for aging-friendly innovations, targeting advocacy efforts at individuals working within government who could become policy entrepreneurs, and working towards vertical diffusion of innovations via state and federal mandates and funding. Finally, survey and interview results hint at additional lines of inquiry that should be pursued as part of a larger aging-friendly communities research agenda. First, what exactly is an aging-friendly innovation or an aging-friendly community? Second, how can communities change their physical and social environment in such a way that the needs and wants of older residents do not impede those of other residents? Finally, and perhaps most importantly, what impact do these policies, programs, and infrastructure changes on the health and well-being of older adults and their ability to age in place

Frailty as a predictor of mortality: a comparative cohort study of older adults in Costa Rica and the United States

Background Frailty is a common condition among older adults that results from aging-related declines in multiple systems. Frailty increases older adults’ vulnerability to negative health outcomes, including loss of mobility, falls, hospitalizations, and mortality. The aim of this study is to examine the association between frailty and mortality in older adults from Costa Rica and the United States. Methods This prospective cohort study uses secondary nationally-representative data of community-dwelling older adults from the Costa Rican Longevity and Healthy Aging Study (CRELES, n=1,790) and the National Health & Aging Trends Study (NHATS, n=6,680). Frailty status was assessed using Physical Frailty Phenotype, which includes the following five criteria: shrinking, exhaustion, low physical activity, muscle weakness, and slow gait. We used Cox proportional hazard models to examine the association between frailty and all-cause mortality, including sociodemographic characteristics and health behaviors as covariates in the models. Mortality follow-up time was right censored at 8 years from the date at baseline interview. Results The death hazard for frail compared to non-frail older adults was three-fold in Costa Rica (HR=3.14, 95% CI: 2.13–4.62) and four-fold in the White US (HR=4.02, 95% CI: 3.04–5.32). Older age, being male, and smoking increased mortality risk in both countries. High education was a protective factor in the US, whereas being married/in union was a protective factor in Costa Rica. In the US, White older adults had a lower risk of death compared to all other races and ethnicities. Conclusions Results indicate that frailty can have a differential impact on mortality depending on the country. Access to universal health care across the life course in Costa Rica and higher levels of stress and social isolation in the US may explain differences observed in end-of-life trajectories among frail older adults.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA)UCR::Vicerrectoría de Docencia::Ciencias Sociales::Facultad de Ciencias Económicas::Escuela de Estadístic