A manifesto for the age-friendly movement

In order to reach an age-friendly environment where older people are actively involved and valued, there are 10 factors that need to be highlighted, according to researchers from Manchester university. Here are the 10 factors towards an age-friendly movement.

Population ageing is putting significant pressure on urban spaces all over the world. Since the mid-2000s, the need to create ‘age-friendly cities and communities’, meaning places where older people are actively involved, valued and supported, has emerged as a major concern for urban policy development.

The World health organization has driven this age-friendly agenda through its Global network for age-friendly cities and communities (GNAFCC). The GNAFCC has had a rapid increase in membership, reaching 821 cities and communities across the world by 2019. This world-wide growth has contributed to the development of age-friendly initiatives addressing diverse issues such as green spaces, mobility and walkability, home adaptions and community services.

Despite these successes, there are questions about the future progress of the urban age-friendly movement. First, the movement has tended to ignore the impact of social and economic inequalities along with the problems facing low-income communities within cities. Second, financial pressures on cities, linked with economic austerity, have placed significant constraints on budgets, reducing the scope of age-friendly initiatives.

Against this background, we have set out a 10 point manifesto for the age-friendly movement. The aim of the manifesto is to stimulate debate and encourage new approaches amongst stakeholders, including urban planners, community developers, health and social care professionals, policy-makers, NGO:s, and not least, older people themselves.

1. Acknowledging urban complexity
The first issue concerns applying ‘age-friendliness’ in a way that recognises the complexity of the global urban environment. The techniques for creating an age-friendly community will vary greatly depending on the characteristics of the urban environment, for example, size and growth patterns, forms of urban development and climate conditions.

There is also a need to re-think approaches in the context of increasingly unequal and unstable societies, with older people displaced by the effects of war, climate change, rural decline and (in the global south) accelerating urban development.

A strong message about maintaining older people actively engaged.

2. Integrating neighbourhood change
Developing an age-friendly approach necessitates recognition the importance of the neighbourhood in the lives of older people. This involves providing access to natural and green spaces, ensuring safety and security, as well as offering a range of housing options.

To date progress has been slow in increasing housing choice, beyond specialist provision such as retirement villages and extra-care housing, despite the fact that the majority of older people prefer to live in communities with a mix of ages. Meeting this demand will require a creative partnership between older people, housing association, building companies and other relevant groups.

3. Challenging social inequality and exclusion
The age-friendly movement contains a strong message about maintaining older people actively engaged in society, but less attention has been paid to the inequalities associated with ageing. The experience of ageing differs between older women and men, different ethnic groups, those with more versus less financial resources, and also varies as a consequence of events such as divorce or redundancy.

A key task for future age-friendly policies will therefore be to increase equity of access to the basic necessities and decision-making processes of urban life, explicitly addressing persisting gender, social class, ethnic and other inequalities in the older population.

4. Incorporating diversity 
Although the age-friendly project has placed older people at the centre of various initiatives, the movement has tended to ignore the full diversity of ageing experiences. Examples include the marginalisation of black and minority ethnic groups and those within the lesbian, gay, bisexual, transgender and queer (lgbtq) communities. Acknowledging social diversity is therefore an important issue.

This means responding to different cultural interpretations of what ‘age-friendliness’ might mean; shaping policies around the needs of particular groups with contrasting migration histories and life course experiences; and tackling distinctive forms of inequality experienced by particular groups, notably in areas such health, income, and housing.

5. Facilitating community empowerment 
The diversity of groups within the older population means that the process of developing age-friendly communities will involve reconciling conflicting interests and concerns. ‘Community empowerment’ can be defined here as the process of enabling all residents to have much greater control over the factors and decisions that shape their lives. Such an approach faces challenges in terms of empowering those older people experiencing different forms of exclusion, such as those facing mobility problems, chronic poverty and forms of discrimination.

A key role for age-friendly policies and initiatives will therefore be to enhance the agency, voice and power of these particular groups by expanding opportunities which facilitate their participation.

Coproduction methods are at the heart of developing age-friendly policies.

6. Coproducing age-friendly communities
The coproduction approach aims to put the abovementioned principles of ‘empowerment’ into practice, by building partnerships between older people, their families and communities, and local organisations. These groups work together to jointly develop research and a shared understanding, as well as to design, develop and deliver opportunities, projects and solutions promoting social and political change. In this sense, coproduction methods are at the heart of developing age friendly policies and initiatives to ensure that older people are recognised as key actors in developing the age-friendliness of their communities.

7. Developing creative and participatory age-friendly design
Discussions about ‘age-friendly design’ have primarily focused on principles of universal and inclusive design by improving mobility, walkability, accessibility and seating. However, it is also important to understand age-friendly design as a process that works via the principles of participation, co-production and empowerment.

There is clear appetite within the policy making community to explore these understandings and practices of age-friendly design, but there is also an opportunity to encourage socially-engaged urban practitioners – developers, architects, designers, artists – to intervene proactively in age-friendly cities and communities.

8. Encouraging multi-sectorial and multidisciplinary collaboration 
The importance of building partnerships between multiple stakeholders and sectors to research and create age-friendly environments for, with and by older people cannot be underestimated. The age-friendly movement has a key role to play by bringing together networks already present in cities and communities to benefit older people.

Strategic partnerships between local authorities, public health professionals, architects, housing providers, community organisations, universities and older people may be especially crucial to achieving successes. Mobilising a range of stakeholders from different sectors and disciplines will be essential for realising the potential benefits that age-friendly communities have to offer.

Mobilising will be essential for realising the benefits that age-friendly communities have.

9. Integrating research with policy
The age-friendly approach has developed at a rapid rate but this has occurred in the absence of a body of research which tells us about the effectiveness and impact of such work. For example, whether it benefits some groups rather than others; what contribution it makes to the wellbeing of older people; whether it leads to improvements in urban design; and whether it strengthens support networks within neighbourhoods.

Establishing answers to these questions will be important if local and municipal authorities are to give financial support to age-friendly programmes. There is a need to create stronger linkages with academic institutions from multiple disciplinary perspectives to build process evaluations and undertake comparative studies.

10. Strengthening international networking
Many of the achievements and advancements in developing age-friendly policies have been fuelled by the who GNAFCC. The network has offered a unifying and integrated narrative to advance ageing work in civil society, government and the private sector.

However, the key question is how to expand and raise the ambition of the age-friendly movement in a difficult economic climate with limited funding and competing demands for resources. This requires creative ways to mobilise new resources, stronger links with academic institutions and researchers, and combining local presence with a true global strategy for the age-friendly movement.

Fakta
STYRKOR OCH SVAGHETER MED DEN EPIDEMIOLOGISKA STUDIEN

Intervjuerna i studien omfattar en rad olika frågebatterier och ger därigenom en rik bild av de allra äldsta personernas levnadsvillkor under perioden. Stora ansträngningar har gjorts under datainsamlingen för att minimera bortfall och försäkra att även de sköraste äldre personerna är representerade i studien. Sammantaget ger detta en god grund för att tro att resultaten från studien återspeglar de faktiska levnadsvillkoren i den äldre befolkningen i Sverige under studieperioden.

Likväl bör resultaten tolkas med försiktighet. De mått som används av psykisk ohälsa är väldigt grova.

I analyserna av prevalenser och trender består de av svar på två direkta frågor om depressiva symtom och ångestproblematik. Frågorna är trubbiga och har inte validerats mot kliniska diagnoser, vilket innebär en osäkerhet om vad måtten faktiskt mäter och i vilken mån de är jämförbara över tid och mellan grupper.

Från 2014 har ett etablerat screeninginstrument för depression, GDS-4, använts. När detta validerade den enskilda frågan om depressiva symtom visade analyserna att den ledde till en substantiell underskattning av förekomsten av depressiva symtom. Detta innebär att prevalenserna av depressiva symtom sannolikt är en underskattning av den sanna prevalensen i den äldre befolkningen.

Det är också möjligt att frågornas grovhet, delvis, kan förklara skillnaderna i resultat mellan den sociala fördelningen av depressiva symtom och ångest: Då depressiva symtom är mätt med ett mer sofistikerat instrument (GDS-4) än ångest (som är mätt med en rak fråga), är det möjligt att på ett  mera effektivt sätt lyckas fånga upp systematiska skillnader i depressiva symtom än i ångest.

Studien bygger också på ett något begränsat representativt urval av äldre personer. Detta innebär att det statistiska underlaget är begränsat ,vilket i sin tur innebär att det finns en betydande osäkerhetsmarginal kring de skattningar som görs i studien.

Slutligen bygger studien på observationsdata, det vill säga på information om de äldre personernas naturligt förekommande levnadsvillkor. Därför kan inte några slutsatser dras om de orsakssamband som ligger bakom sambanden som observeras i studien. För vissa av de riskfaktorer som studeras finns dock goda grunder att anta att ett orsakssamband föreligger, medan det för andra är mer osäkert.

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Genom Age-friendly cities-samarbetet arbetar fyra svenska kommuner med att bli mer äldrevänliga. Uppsala har kommit längst i den processen.

Åldersvänlig strävan i svensk kvartett

I WHO:s nätverk Age-friendly cities and communitites ingår drygt 820 kommuner i världen. Fyra finns i Sverige: Göteborg, Hallstahammar, Stockholm och Uppsala.

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Samhällen som vill bli åldersvänliga behöver göra fyra saker: lyssna och förstå äldres behov, planera, agera och utvärdera. Det säger Alana Officer, som är rådgivare på Världshälsoorganisationen i Genève.

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