Transcript The Aging Phenomenon: Housing for an Aging Society

Alan DeLaTorre, PhD
Institute on Aging
Portland State University
[email protected]
Active Ageing: A Policy Framework
(World Health Organization, 2002)
Health and Social Services
 Behavioral Determinants
 Personal Determinants
 Physical Determinants
 Physical Environment
 Social Determinants
 Economic Determinants
 Gender
 Culture

One 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
relationships
 Meso – The neighborhood and
community
 Macro – Larger connections such as
policies, laws, systems, and societal
relationships
Ecological 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:
1.
Behavior both affects, and is affected by, multiple levels of
influence
2.
Individual behavior both shapes, and is shaped by, the social
environment (i.e., reciprocal causation)
Ecological Model (NIH, 2005)
Ecologic 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).
Lawton’s Ecological Model
Gerontology 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).
From 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
Factors that Contribute to the Health and Wellbeing 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:
1.
2.
3.
4.
5.
6.
7.
Individual factors
Social factors
Aggregated population characteristics
Physical environments
Institutional and service environments
Economic factors
Public policy

Factors 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
settings
2. An acute change in health status leading to
hospitalization or short-term rehabilitation
3. Limits on services available in a home care program
4. Mental health, legal issues, and falls
1.
Robison, Shugrue, Porter, Fortinsky, & Curry (2012).
Journal of Aging and Social Policy, 24, 251-270
Nursing 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
needs
Robison
et al., (2012),
Journal of Aging and Social Policy.

Nursing Home Transition from HCBS (cont.)
Several recommendations were given for moving
from research findings to policy and practice






More structured coordination with hospital and nursing
home discharge planners
Family 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 reduction
Innovative transportation solutions (e.g., cooperative
models and/or nonprofit agencies providing services)
Mental health/substance abuse services for older adults
Robison et al., (2012), Journal of Aging and Social Policy.
Housing 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
integration
 Farber, Shinkle, Lynott, Fox-
Grage, & Harrell (2011)
www.joblo.com
What 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 desires

An interesting questions emerges:
Should we facilitate aging in place or
aging in community?
Universal 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 Mace
► Universal
design benefits people of all ages
and abilities
The Center for Universal Design (CUD) – North Carolina State
University: http://www.design.ncsu.edu/cud/
“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 housing
►
Refers 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 walkers
►
The inflexible features are:
 Wide passage doors
 At least a half bath/powder room on the main floor
 At least one zero-step entrance
http://www.visitability.org/
The Details of Visitability
►
An entrance without a step or threshold that is on an
accessible path of travel from the street, sidewalk or
driveway
 An 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 space
 hallways that have at least 36 inches of clear width
►
Basic access to a half bath or full bath on the ground floor
 As 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 Buffalo
Making the case for the broad
application of accessible design
*Access is cost-effective if planned in advance
New Construction
Retrofitting
Zero-Step Entrance
$200
$3,300
Widen Interior Doors
$50
$700
Source (2012): Concrete Change
http://www.concretechange.org
Source: University of Buffalo
Flexible 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, 1990
►
Important elements:
 Placing studs that will allow for grab bars





in
the future
Being able to convert part of the house
into an accessory dwelling unit in the future
Adjustable countertops and cupboards
Zero-step entrance
Bathroom and bedroom on main level
Outlets at waist-level
http://savoirfair.org
Age-friendly Cities and Communities
Origins of Age-Friendly Cities Project

2005 – Original Age-Friendly Cities project
conceived at the International Association of
Gerontology and Geriatrics in Rio de Janeiro, Brazil
 Immediately attracted enthusiastic interest

WHO advisory group guided project development
 Included WHO staff and international representatives from
public, non-governmental, university, and advocacy groups

Funding 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
The Age-Friendly City Model


WHO’s focus on “agefriendly” cities emerged
from its “active aging”
model
Active aging:
 Involves optimizing
opportunities for health,
participation, & security
 Is determined by various
factors that are
cumulative over the life
course
Development of the WHO’s
Age-Friendly Cities research
project
2006 – Initial meeting of advisers in Vancouver,
Canada
Experts in policy, community action, and qualitative research convened
 Attendees 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-friendliness
 Identify areas for remedial action
 Contribute to WHO’s objective of
identifying the essential features
of an age-friendly city

Study Objectives

For 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-friendly

For participating cities: to increase awareness of
local needs, gaps and good ideas for improvement in
order to stimulate development of more age-friendly
urban settings
An “Age-Friendly” City:

Is a World Health Organization designation

Is 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”
Implementing the WHO’s
Age-Friendly Cities Protocol

Eight features of urban life were identified for
examination in the Vancouver protocol

Semi-structured focus groups were required where
participants were asked to identify positive and
negative features of the city and to offer suggestions
for improvement

Informed consent/ethics review was mandatory
An Age-Friendly City: Eight Domains
Source: Suzanne Garon,
University of Sherbrooke
Implementation (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 conferences

Focus groups were conducted in 33 cities in 22 countries
158 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 countries
 Areas within 7 mega cities (10 million +) were included: Mexico City,
Moscow, New Delhi, Rio de Janeiro, Istanbul, Shanghai, and Tokyo
 Smaller cities/communities/neighborhoods also were involved

AMERICAS
Original Age-Friendly Collaborating Cities
Argentina, La Plata
Brazil, Rio de Janeiro
Canada, Halifax
Canada, Portage La Prairie
Canada, Saanich
Canada, Sherbrooke
Costa Rica, San Jose
Jamaica, Kingston
Jamaica, Montego Bay
Mexico, Cancun
Mexico, Mexico City
Puerto Rico, Mayaguez
Puerto Rico, Ponce
USA, Portland
USA, New York
EUROPE
Germany, Ruhr
Ireland, Dundalk
Italy, Udine
Russia, Moscow
Russia, Tuymazy
Switzerland, Geneva
Turkey, Istanbul
UK, Edinburgh
UK, London
AFRICA
SOUTH-EAST ASIA
Kenya, Nairobi
India, New Delhi
India, Udaipur
WESTERN PACIFIC
EASTERN MEDITERRANEAN
Jordan, Amman
Lebanon, Tripoli
Pakistan, Islamabad
Image Credit:
BC Ministry of Health
Australia, Melbourne
Australia, Melville
China, Shanghai
Japan, Himeji
Japan, Tokyo
Implementation: 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, Kenya
Help the Aged UK contracted with HelpAge India to conduct
the research in two cities in India
The Guide & Checklist

The recurring themes and variations
among communities were reported in
detail in the WHO main report: Global
Age-friendly Cities: A Guide

→
A 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 Cities

→
The 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
http://www.who.int/ageing/age_friendly_cities_guide/en/
The Launch of Findings: 2007

The United Nations recognizes
October 1st as International
Day of Older Persons

WHO launched the Global
Guide on October 1st, 2007 in
London (English) and Geneva
(French)

Alexandre Kalache, former Director of
WHO's Life Course and Aging Programme,
speaks about age-friendly cities
Cities around the world were
encouraged to have special
events to launch their findings

For example, in Portland we presented
findings to government leaders and
media at City Hall
Canadian Health Minister Tony Clement (right)
accepts an international award from Help the
Aged UK as part of the launch of findings
The 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 movement

To 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 Agefriendly Cities

Recently, the WHO has added “Communities” to the
program name based on requests from non-urban areas
Goals and Requirements of the Network

Goals:
 To provide technical support and training
 To link cities and communities to WHO and each other
 To facilitate the exchange of information and best practices
 To ensure that interventions taken to improve the lives of older people
are appropriate, sustainable and cost-effective

Membership requirements:
 City must commit to undertaking a process of continually assessing
and improving its age-friendliness
 Older residents must be involved in a meaningful way throughout the
process
 City must complete an online application form and submit a letter from
the mayor/municipal administration indicating commitment
WHO Proposed Cycle for Members of the
Global Network of Age-friendly Cities©
Years 1-2
1. Joining the network
• Involve older people
• Baseline assessment
of age-friendliness
• Develop action plan
• Identify indicators
Years 3-5
2. Implementation
•
•
Implement
action plan
Monitor indicators
3. Evaluate progress
and continual
improvement
• Measure progress
• Identify success
and remaining gaps
• Develop new action plan
Ongoing 5-year cycles
Current WHO Global Network of Agefriendly Cities and Communities

As of March, 2013 there were 138 cities in 21
countries across the world

There 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.
WHO Age-Friendly Cities Project
in Portland, Oregon
Select Findings
Outdoor Spaces &
Buildings
Housing
Even more natural features & green
spaces were desired, with attention toward
accessibility
More affordable & accessible housing was
suggested (e.g., infill development such as
below seen as inadequate)
“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
Select Findings (cont.)
Transportation
Regional transportation options were
considered age-friendly, but improvements
were suggested
Social Participation
Many educational and social opportunities
were noted, but additional options were
desired
www.pdx.edu
Select Findings (cont.)
Respect & Social Inclusion
Civic Participation &
Employment
Language and inclusion matter! Terms such Employment and volunteer opportunities for
as “honored citizen” and “long-term living”
older adults, especially those with lower
were preferred, and organizations were
incomes and less education, were advocated
encouraged to consult and listen to the
advice of older adults
www.trimet.org
Select Findings (cont.)
Communication &
Information
Opportunities to learn how to use
technology were seen as important, but
services should not assume access and
proficiency by all
Community Support &
Health Services
Connecting necessary services to people was
seen as critical to making Portland age
friendly
“Portland [will be] a Place for All
Generations”

Draft Plan released March, 2012

Written comments were submitted
that specifically addressed needed
improvements to the Plan

BPS requested a meeting with aging
and disability representatives to
discuss written comments

March 19, 2012 – We were asked
to present to Portland’s Planning
Commission

Final result: Portland Plan now
specifically addresses how Portland
can become a more age-friendly city
Portland Plan Action Items

Develop an age-friendly city action plan

Prioritize expansion and availability of accessible housing

Concentrate on age-friendly, accessible community hubs

Foster safe and accessible civic corridors (e.g.,
infrastructure and transit)

Increase access to and services within medical
institutions

Increase inter-generational mentoring opportunities

Bolster framework for equity, including integration with
newly forming City of Portland Office of Equity
Proposed (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)
Proposed Guiding Principles of Sustainable
Development for an Aging Population
1. 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.
2. 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.
3. Value culture, wisdom, and other assets that exist throughout the life course.
4. 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.
5. Create viable and sustainable economic resources that utilize the assets of people of all
ages and abilities.
Proposed Guiding Principles of Sustainable
Development for an Aging Population (cont.)
6. Provide appropriate community and health services that focus on enhancing independence
and well-being in an affordable and efficient manner.
7.
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.
8. 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.
9. Foster the creation of accessible and useful places for social interaction and civic activities
within and in close proximity to housing for older adults.
10. 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.
For more information:
Alan DeLaTorre, Ph.D.
Institute on Aging
Portland State University
503.725.5236
[email protected]
Thank you!
Questions?