Presentation on theme: "A Primer on Environmental Gerontology"— Presentation transcript:
1A Primer on Environmental Gerontology Alan DeLaTorre, PhDInstitute on AgingPortland State University
2Active Ageing: A Policy Framework (World Health Organization, 2002) Health and Social ServicesBehavioral DeterminantsPersonal DeterminantsPhysical DeterminantsPhysical EnvironmentSocial DeterminantsEconomic DeterminantsGenderCulture
3One lens for thinking about living arrangements for older adults is the Ecologic Model This framework can be applied to many topics and in a variety of ways and incorporated several levels:Micro – The home and immediate surroundings, including personal relationshipsMeso – The neighborhood and communityMacro – Larger connections such as policies, laws, systems, and societal relationships
4Ecological Perspective (Theory at a Glance: A Guide for Health Promotion Practice: NIH, 2005) The ecological perspective emphasizes the interaction between, and interdependence of, factors within and across all levels of a health problem.It highlights people’s interactions with their physical and social environments.Two key concepts of the ecological perspective help to identify intervention points for promoting health:Behavior both affects, and is affected by, multiple levels of influenceIndividual behavior both shapes, and is shaped by, the social environment (i.e., reciprocal causation)
6Ecologic Model of Environment and Aging Lawton and Nahemow’s (1973) described interdependence of the various elements in a system and stressed the fact that there is a continual process of adaptation, from both older people and their environments.The field of public health has also utilized an ecologic model for building healthy communities; myriad factors influence healthy behaviors: biological, behavioral, social, and environmental variables (Satariano & McAuley, 2003).
8Gerontology and Public Health Ecological Models Both the gerontology and public health ecological models focus on attributes of the individual (e.g., the aging body, disease and disability, individual behavior) and the environment (e.g., accessibility and usability, social connections and interaction, healthy housing).
9From Theory to Practice An ecologic model is useful in framing research and moving toward implementation efforts (Sallis, 2003).Moving beyond basic research and has been identified as an important next step for broadening the effectiveness of the ecologic model (Cunningham and Michael, 2004)The result would be action-based research that considers the social, biological, behavioral and environmental factors while understanding the dynamic interplay over time that occurs between older people and their environments
10Factors that Contribute to the Health and Well-being of Older Adults in Cities and Communities The following factors were identified by combining the core aspects of the social ecological models in public health and gerontology with the WHO’s active ageing framework and domains of age-friendly cities and communities:Individual factorsSocial factorsAggregated population characteristicsPhysical environmentsInstitutional and service environmentsEconomic factorsPublic policy
11Factors Leading to Nursing Home Transition from HCBS Programs Based on a review of case notes, four general factors were shown to contribute to ending home health and moving to long-term care settings:Family availability and family/client preferences for care settingsAn acute change in health status leading to hospitalization or short-term rehabilitationLimits on services available in a home care programMental health, legal issues, and fallsRobison, Shugrue, Porter, Fortinsky, & Curry (2012) Journal of Aging and Social Policy, 24,
12Nursing Home Transition from HCBS (cont.) Based on focus group research with clients who transitioned, several additional system-level factors were identified:Staffing: lack of home care providers on nights and weekends, limits on covered services, high turnover rates, uneven quality, low pay, language barriers, and the need for home care workers who could provide a wide range of service (from hands-on to homemaker)Lack appropriate housing features, inadequate adult ay programs and respite care, and the need to educate family members about participant needsRobison et al., (2012), Journal of Aging and Social Policy.
13Nursing Home Transition from HCBS (cont.) Several recommendations were given for moving from research findings to policy and practiceMore structured coordination with hospital and nursing home discharge plannersFamily and caregiver support is needed (e.g., caregiver support, respite programs, adult day programs)Employer recommendation: flexible work schedules, telecommuting, paid time off, in-person and online support for eldercare providers, and wellness program that include exercise and stress reductionInnovative transportation solutions (e.g., cooperative models and/or nonprofit agencies providing services)Mental health/substance abuse services for older adultsRobison et al., (2012), Journal of Aging and Social Policy.
14Housing and Communities Across the Life Course There is an urgent call for planners and policymakers to prepare for the rapidly aging society, including addressing the specific need for planning and developing affordable housing for an aging population that is well designed, connected to essential services and infrastructure, and fosters social and community integrationFarber, Shinkle, Lynott, Fox-Grage, & Harrell (2011)14
15What is Aging in Place?Not having to move from one’s present residence in order to secure necessary support services in response to changing needs (Journal of Housing for the Elderly)Or, more simply out, growing older in the location that one desiresAn interesting questions emerges:Should we facilitate aging in place or aging in community?15
16Universal Design“Universal design is the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design” –Ron MaceUniversal design benefits people of all ages and abilitiesThe Center for Universal Design (CUD) – North Carolina State University:16
17“Visit-ability” or “Visitability” “Visit-ability” or “Visitability” is an affordable, sustainable and inclusive design approach for integrating basic accessibility features into all newly built homes and housingRefers to single-family or owner-occupied housing designed in such a way that it can be lived in or visited by people who have trouble with steps or who use wheelchairs or walkersThe inflexible features are:Wide passage doorsAt least a half bath/powder room on the main floorAt least one zero-step entrance17
18The Details of Visitability An entrance without a step or threshold that is on an accessible path of travel from the street, sidewalk or drivewayAn accessible path of travel has no steps, is at least 36 inches wide and is not steeper than 1:20 (5% grade) for walkways or 1:12 for ramps.Throughout the ground floor:doorways designed to provide 32 inches of clear spacehallways that have at least 36 inches of clear widthBasic access to a half bath or full bath on the ground floorAs defined here, basic access simply denotes sufficient depth within the bathroom for a person in a wheelchair to enter, and close the door-Rehabilitation Engineering Research Center on Universal Design at Buffalo18
19Making the case for the broad application of accessible design *Access is cost-effective if planned in advanceNew ConstructionRetrofittingZero-Step Entrance$200$3,300Widen Interior Doors$50$700Source (2012): Concrete Change19
22Flexible housing design Flexible housing is a way of easing the shortage of affordable housing by designing new and rehabilitated single family residences so that accessory apartments are easily and cost-effectively created or removed.Howe, 1990Important elements:Placing studs that will allow for grab bars in the futureBeing able to convert part of the house into an accessory dwelling unit in the futureAdjustable countertops and cupboardsZero-step entranceBathroom and bedroom on main levelOutlets at waist-level22
24Origins of Age-Friendly Cities Project 2005 – Original Age-Friendly Cities project conceived at the International Association of Gerontology and Geriatrics in Rio de Janeiro, BrazilImmediately attracted enthusiastic interestWHO advisory group guided project developmentIncluded WHO staff and international representatives from public, non-governmental, university, and advocacy groupsFunding and in-kind support from the Public Health Agency of Canada helped in developing and implementing the project and publishing the final report: Global Age-Friendly Cities: A Guide
25The Age-Friendly City Model WHO’s focus on “age-friendly” cities emerged from its “active aging” modelActive aging:Involves optimizing opportunities for health, participation, & securityIs determined by various factors that are cumulative over the life course→
26Development of the WHO’s Age-Friendly Cities research project 2006 – Initial meeting of advisers in Vancouver, CanadaExperts in policy, community action, and qualitative research convenedAttendees were familiar with the social context of both developing and developed countries“Vancouver protocol” was created to:Guide collaborating groups to use a standardized method to assess their community’s age-friendlinessIdentify areas for remedial actionContribute to WHO’s objective of identifying the essential features of an age-friendly city
27Study ObjectivesFor WHO: to identify concrete indicators of an age-friendly city and produce a practical guide to stimulate and guide advocacy, community development and policy change to make urban communities age-friendlyFor participating cities: to increase awareness of local needs, gaps and good ideas for improvement in order to stimulate development of more age-friendly urban settings2727
28An “Age-Friendly” City: Is a World Health Organization designationIs defined as a city that:is “an inclusive and accessible urban environment that promotes active ageing”“emphasizes enablement rather than disablement”“is friendly for all ages, not just age-friendly”
29Implementing the WHO’s Age-Friendly Cities Protocol Eight features of urban life were identified for examination in the Vancouver protocolSemi-structured focus groups were required where participants were asked to identify positive and negative features of the city and to offer suggestions for improvementInformed consent/ethics review was mandatory
30An Age-Friendly City: Eight Domains Source: Suzanne Garon,University of Sherbrooke
31Implementation (cont.) Project sites were recruited through informal networks of WHO project leaders, connections to municipal or state governments, and promotion of the project at professional conferencesFocus groups were conducted in 33 cities in 22 countries158 focus groups with people aged 60+ (n = 1,485)Some sites conducted caregiver focus groups (n = 250)Some sites conducted focus groups with service providers in public, voluntary & commercial sectors (n = 515)Participating cities were diverse:19 developing and 14 industrialized countriesAreas within 7 mega cities (10 million +) were included: Mexico City, Moscow, New Delhi, Rio de Janeiro, Istanbul, Shanghai, and TokyoSmaller cities/communities/neighborhoods also were involved
32Original Age-Friendly Collaborating Cities AMERICASArgentina, La PlataBrazil, Rio de JaneiroCanada, HalifaxCanada, Portage La PrairieCanada, SaanichCanada, SherbrookeCosta Rica, San JoseJamaica, KingstonJamaica, Montego BayMexico, CancunMexico, Mexico CityPuerto Rico, MayaguezPuerto Rico, PonceUSA, PortlandUSA, New YorkAFRICAKenya, NairobiEUROPEGermany, RuhrIreland, DundalkItaly, UdineRussia, MoscowRussia, TuymazySwitzerland, GenevaTurkey, IstanbulUK, EdinburghUK, LondonEASTERN MEDITERRANEANJordan, AmmanLebanon, TripoliPakistan, IslamabadSOUTH-EAST ASIAIndia, New DelhiIndia, UdaipurWESTERN PACIFICAustralia, MelbourneAustralia, MelvilleChina, ShanghaiJapan, HimejiJapan, TokyoImage Credit:BC Ministry of Health3232
33Implementation: Assistance for Developing Countries Public Health Agency of Canada allowed WHO to award small research contracts to NGOs & research centers in developing world:Jamaica, Mexico, Costa Rica, Brazil, Argentina, Libya, KenyaHelp the Aged UK contracted with HelpAge India to conduct the research in two cities in India
34The Guide & Checklist → → The recurring themes and variations among communities were reported in detail in the WHO main report: Global Age-friendly Cities: A GuideA set of core features of an age-friendly city was identified in the Guide and in a four-page Checklist of Essential Features of Age-friendly CitiesThe Guide and Checklist are intended to serve as a reference for other communities to assess their strengths and gaps, advocate for and plan change, and monitor progress→→
35The Launch of Findings: 2007 The United Nations recognizes October 1st as International Day of Older PersonsWHO launched the Global Guide on October 1st, 2007 in London (English) and Geneva (French)Cities around the world were encouraged to have special events to launch their findingsFor example, in Portland we presented findings to government leaders and media at City HallAlexandre Kalache, former Director of WHO's Life Course and Aging Programme, speaks about age-friendly citiesCanadian Health Minister Tony Clement (right) accepts an international award from Help the Aged UK as part of the launch of findings
36The WHO Global Network of Age-Friendly Cities (and Communities) After the initial Age-Friendly Cities project, the WHO was overwhelmed by positive responses, and new cities around the world wished to join this global movementTo support cities wanting to follow the approach, and to ensure the quality of the tools and interventions they use, the WHO established the WHO Global Network of Age-friendly CitiesRecently, the WHO has added “Communities” to the program name based on requests from non-urban areas
37Goals and Requirements of the Network To provide technical support and trainingTo link cities and communities to WHO and each otherTo facilitate the exchange of information and best practicesTo ensure that interventions taken to improve the lives of older people are appropriate, sustainable and cost-effectiveMembership requirements:City must commit to undertaking a process of continually assessing and improving its age-friendlinessOlder residents must be involved in a meaningful way throughout the processCity must complete an online application form and submit a letter from the mayor/municipal administration indicating commitment
39Current WHO Global Network of Age-friendly Cities and Communities As of March, 2013 there were 138 cities in 21 countries across the worldThere were 10 affiliated programs coordinating municipal efforts worldwide (e.g., AARP in the U.S., Pan Canadian Initiative, Ageing Well Network in Ireland)Current countries in the network: Andorra, Argentina, Australia, Belgium, Canada, China, Finland, France, Ireland, Israel, India, Japan, Mexico, Portugal, Russian Federation, Slovenia, Spain, Sri Lanka, Switzerland, UK, & U.S.
40WHO Age-Friendly Cities Project in Portland, Oregon Explain the reasons why Portland was selected – Dr. Martha Pelaez suggested Portland and researchers at the IOA/PSU4040
41Outdoor Spaces & Buildings Select FindingsHousingMore affordable & accessible housing was suggested (e.g., infill development such as below seen as inadequate)Outdoor Spaces & BuildingsEven more natural features & green spaces were desired, with attention toward accessibility“A reporter [called] me and [told] me he was writing an article about new homes in the Portland area, brand new construction built to be accessible, and I laughed and said it would be a very short article.” – Design Expert
42Select Findings (cont.) TransportationRegional transportation options were considered age-friendly, but improvements were suggestedSocial ParticipationMany educational and social opportunities were noted, but additional options were desired
43Select Findings (cont.) Respect & Social InclusionLanguage and inclusion matter! Terms such as “honored citizen” and “long-term living” were preferred, and organizations were encouraged to consult and listen to the advice of older adultsCivic Participation & EmploymentEmployment and volunteer opportunities for older adults, especially those with lower incomes and less education, were advocated
44Communication & Information Community Support & Health Services Select Findings (cont.)Communication & InformationOpportunities to learn how to use technology were seen as important, but services should not assume access and proficiency by allCommunity Support & Health ServicesConnecting necessary services to people was seen as critical to making Portland age friendly
45“Portland [will be] a Place for All Generations” Draft Plan released March, 2012Written comments were submitted that specifically addressed needed improvements to the PlanBPS requested a meeting with aging and disability representatives to discuss written commentsMarch 19, 2012 – We were asked to present to Portland’s Planning CommissionFinal result: Portland Plan now specifically addresses how Portland can become a more age-friendly city
46Portland Plan Action Items Develop an age-friendly city action planPrioritize expansion and availability of accessible housingConcentrate on age-friendly, accessible community hubsFoster safe and accessible civic corridors (e.g., infrastructure and transit)Increase access to and services within medical institutionsIncrease inter-generational mentoring opportunitiesBolster framework for equity, including integration with newly forming City of Portland Office of Equity
47Proposed (revised) definition of Sustainable Development Sustainable development seeks to meet human needs while cultivating opportunities for human development across the life course, cultures, and geographies. Such development must address the current generations’ ability to sustain their quality of life and well-being while maintaining the ability for future generations to do the same. Furthermore, human development must be integrated into evolving ecological systems by balancing aspects of the natural, built, and social environments. Growth patterns, services, and underlying economic systems must foster social equity in a manner that leads to the health of people, places and systems, both now and in the future.DeLaTorre, A., 2013 (Dissertation findings)
48Proposed Guiding Principles of Sustainable Development for an Aging Population Share best practices among municipalities that pertain to sustainable housing and communities for an aging society and adopt or adapt those in an effort to best serve local and regional needs and abilities.Enable meaningful processes, participation, and partnerships across sectors, organizations, and community stakeholders in an attempt to achieve informed decision making and to bolster community development efforts.Value culture, wisdom, and other assets that exist throughout the life course.Consider social equity implications when creating and/or refining policies and programs in order to provide an appropriate collective response that addresses the identified needs of vulnerable populations and protected classes of people.Create viable and sustainable economic resources that utilize the assets of people of all ages and abilities.
49Proposed Guiding Principles of Sustainable Development for an Aging Population (cont.) Provide appropriate community and health services that focus on enhancing independence and well-being in an affordable and efficient manner.Expand environmental sustainability and green building principles to better address the planning and development of healthy housing and communities that are appropriately and accessibly designed.Refine codes, regulations, plans, and strategies to better align the proximity of and connections between accessible housing, transportation, and land uses in order to create efficient infrastructure systems and appropriate levels of density for an aging society.Foster the creation of accessible and useful places for social interaction and civic activities within and in close proximity to housing for older adults.Integrate research efforts in gerontology, urban planning, public health, and related fields in an attempt to inform practice and improve the implementation of housing and community development policies and programs.
50Portland State University For more information:Alan DeLaTorre, Ph.D.Institute on AgingPortland State UniversityThank you! Questions?