services to different groups of older people (demographics, countries, cultures). Example: As described in the National Institute on Aging’s (2011) Global Health and Aging report, “Health systems need better data to understand the health risks faced by older people and to target appropriate prevention and intervention services” (NIA 2011, 16-17). Implications In these HAPI Research Briefs we aimed to find implications for planning and design at roughly the neighborhood level. These could include quantifiable standards, more qualitative but yet evidence-supported insights, and other good practices. Not every topic has a full complement of these implications. Many of the implications for healthier aging involve individual behaviors by older people. In these cases environments can mainly support healthier options or at least not provide barriers to such healthier behaviors. It is important to keep in mind that planning and design are only part of the picture, because a person’s health and exposure to health risks in childhood and adulthood profoundly affects physical and cognitive functioning in later years (Wen and Gu 2011, 153). Table 4 describes individual behaviors shown to have an effect on disease reduction and prevention in later years. Following this table are policy, planning, and design ideas to promote and support healthy aging (see Table 5).
PHYSIOLOGY AND PSYCHOLOGY OF AGING, HEALTH, AND PLACE Table 4. Individual behaviors to encourage healthy aging for those 65 years or older. 4 Behavior Guidelines Effect
Get regular exercise 30 minutes of moderate-intensity endurance activity on most or all days of the week
Prevent many diseases: type 2 diabetes, certain cancers, obesity, osteoporosis/ osteoarthritis, cardiovascular disease Eat a healthy diet with lots of fruits and vegetables 2.5 cups of vegetables and fruits per day; foods fortified with vitamin B 12 (fortified cereals, dietary supplements) Reduced risk of many chronic diseases: cardiovascular disease, certain types of cancer Do not smoke or use tobacco products No smoking or tobacco products Reduced risk of cardiovascular disease and certain types of cancer Avoid excessive use of alcohol No more than 7 drinks a week, no more than 3 drinks per day; Do not drink and drive Reduce risk of dependency, organ damage, accidents Keep engaged mentally and socially Spouse, family, friends, religious affiliation and attendance, employment, other community affiliations Reduced risk of depression, stress, and cognitive decline; Promotes greater health, longevity and wellbeing, recovery from illness and injury, health behaviors Get regular medical checkups For example, annual physical or as recommended by a doctor Disease prevention and management Safety habits around the home and car For example, wear a seat belt, use handrails and assistive equipment if necessary Prevent falls and fractures, accidents 4. Birren and Schaie 2011, 96-97; Morgan and Kunkel 2001, 6; NIA 2009 (updated 2012), 3; NIA et al. 2011, 24; NIH 2013, 110; Resnick et al 2011, 6; Rowe and Kahn 1987, 146-147; Taylor and Johnson 2007, x; USDA 2010, 34-35; Whitbourne 2002, 10.
Social engagement plays an important role in the health and wellbeing of older adults. Photo by Ann Forsyth
page 9 Insights While individual behavior is the most important factor for healthy aging, planners and policy makers can support individuals in these activities in several ways. A number of recent studies and reviews have described policy and planning interventions that are supportive of healthy aging, especially the World Health Organization’s (2007) Checklist of Essential Features of Age-friendly Cities. These topics are also discussed in more detail in the related syntheses of physical activity, healthy eating options, universal design, social capital, healthcare access, and safety. Table 5 summarizes some age-friendly environmental characteristics with intervention examples and potential health impacts. Table 5. Environmental features which support healthy aging 5 Environmental Features Intervention Examples Potential Health Impact Land use promotes walkability (density, mixed use, connectivity) • Smart Growth development patterns • Retrofitting suburbs • Walkways and cycle paths • Age-friendly residences close to shops Physical activity, walking Safe and accessible streets and sidewalks • Pedestrian countdown signals (slower walking speeds) • Adequate lighting • Clear signage (wayfinding) • Benches • Smooth, level, non-slip surfaces • Sufficient sidewalk width for wheelchairs • Curb cuts • Priority access for pedestrians • Low traffic noise • Public toilets available
Safety (traffic), physical activity
(walking), independence and wellbeing Affordable, accessible homes (universal design) • Build into new construction (ideally), but also retrofitting, funding, zoning, development incentives, or design requirement • Low-income housing programs • Age-specific housing • Options of designs to accommodate single living, multigenerational, and assisted living housing • Universal design features like single level, ramps, wide doorways, etc. Safety (accidents), greater independence and wellbeing Accessible buildings (universal design) • Elevators, escalators, ramps • Wide doorways and passageways • Suitable stairs with railings • Non-slip flooring • Rest areas and public toilets with handicap access • Adequate signage Safety (accidents), greater independence and wellbeing 5. Hunter et al. 2011, 357-359, 360, 361, 363; Parra 2010, 1073; WHO 2007, 12-17, 20-27, 30-34, 44, 58-59, 71
PHYSIOLOGY AND PSYCHOLOGY OF AGING, HEALTH, AND PLACE Environmental Features Intervention Examples Potential Health Impact Safety from crime (real or perceived), lighting, etc. • Surveillance cameras • Self-organized groups • Grants to improve personal security • Lighting Safety (crime), physical activity (walking), mental health Adequate transportation (personal, public, or specialized transport options) •
Driving conditions: enhancements to highway design (wayfinding), lower speed routes, connectivity of streets, reduced intersection widths, complete street design
• Transportation options: taxis, community transport, para-transit options; available, safe, affordable, and reliable public transportation (vehicles and stations) with handicapped accessibility and seating, adequate parking (handicapped accessible) Independence, wellbeing, social and community life, mental health Density of parks, greenspace (perceived as safe) • Plenty of available parks and greenspace • Small, quiet areas • Special gardens or areas just for older people • Park maintenance Physical activity (walking), mental health, “good” reported health status Pleasant and clean environment • Noise ordinances • Sanitation, street cleaning, and garbage collection • Adequate public toilets Mental health, physical activity, wellbeing Public events that are accessible, affordable, and appealing • Located and scheduled conveniently to older people • Open admission, affordable • Diversity of events and activities Social capital, wellbeing, mental health, supports cognitive, mental and social activity Volunteering, employment and training options • Volunteer databases • Policy and legislation to prevent discrimination