Is age-friendliness for everyone? Or just for older people?

Judith Davey

21/04/2017

“towards a society for all ages”

This was the slogan for the United Nations’ International Year of Older Persons in 1999.

But if you google anything about the year, not to mention “age-friendliness,” the photos you see will almost always depict older people. What does ‘age-friendliness’ actually mean? Is the inclusion of ‘all ages’ a way of advancing design, housing features and urban developments that take specifically older adults into account while asserting that this will lead to universal good/benefit? Do age-friendly initiatives really create an environment which benefits all ages?

It is interesting to note that, well before the International Year of Older Persons, the World Health Organisation (WHO), now the main global protagonist of age friendly cities and communities, changed its focus from “the elderly” to “ageing,” to remind everyone that good health is everybody’s business.

More recently, the New Zealand Health of Older People Strategy changed its title to the Healthy Ageing Strategy. Do these changes recognise a shift in thinking, to a wider view? If we say “older people” or “seniors”, this focuses attention on a fixed group, identified by age or life stage. ‘Ageing’ attempts to resolve this limitation by focusing on a process which everyone is undergoing from the moment they are born and makes it easier for everyone to identify with it. It also avoids the problem of having to suggest an age at which people can begin to be considered “old”.

WHO has continued to support this trend, stating “An age-friendly city emphasizes enablement rather than disablement; it is friendly for all ages and not just ‘elder-friendly’”. Indeed, the notion that ‘age-friendliness benefits all ages’ forms one of the arguments to support investment in urban improvements, especially the physical aspects of urban design: better footpaths and pedestrian crossings, parks and recreation facilities, and transport services, aiming for a ‘community for all ages’. Is this a great idea to promote “buy-in “or does it run the danger of eclipsing the specific needs of older people?

Intergenerational factors
Using “ageing” as the focus brings in intergenerational issues. Some studies in the Age-friendly Cities and Communities (AFCC) literature emphasise the importance of opportunities for social integration and interaction between older and younger people. This shifts the age-friendly focus away from older people to one where social and physical facilities benefit everyone. For example, a study of younger and older adult bus users found that creating an age-friendly bus service would benefit all users. Measures to combat social exclusion often include intergenerational interaction and opportunities to develop activities that span the generations. Social relationships are important to the well-being of people of all ages. And promoting intergenerational solidarity is helpful in combatting arguments which pit the generations against each other, such as tax and retirement income policies.

 

[1] WHO (2007) Global age friendly cities: A guide. World Health Organisation, Geneva.

who.int/ageing/projects/age_friendly_cities_network/en/ NETWORK

[2] Broome, K., McKenna, K., Fleming, J. and Worrall, L. (2009) Bus use and older people: A literature review applying the person-environment-occupation model in macro practice. Scandinavian Journal of Occupational Therapy, 16 p.3–12.

 

Participation in volunteering can be a way to promote intergenerational relationships. These could include projects in which ‘young old’ are paired with ‘old–old’. Younger seniors could be encouraged to provide psychological and physical support for older seniors. This is a basis for ‘befriending” schemes, such as Age Concern’s Accredited Visitors Service.

Further examples of intergenerational programmes come from the USA.

• Generations of Hope, in Illinois , represents an intergenerational approach designed to promote social capital and social inclusion. It fosters mutually beneficial social relationships between older adults and younger people who are experiencing personal and social challenges, such as substance abuse, domestic violence or homelessness.

• Communities for All Ages (CFAA) is also based on an intergenerational approach to community-building that involves residents of all ages, local organisations, policy makers and funders. Attempts to break through age-specific ‘silos’ include multi-generational neighbourhood learning and community centres, Farmers Markets and Arts Festivals.

However, the extent to which intergenerational programmes and structures such as these result in sustained social capital formation and social inclusion needs to be assessed. Other initiatives include intergenerational meeting places to facilitate social contact; programmes to encourage connection with neighbours; intergenerational and multi-ethnic community centres, library programmes, and cultural events. Such initiatives have been frequently identified as ways to encourage age-integrated neighbourhoods.

“Design for the young and you exclude the old; design for the old and you include the young.”

The notion of ‘a design for all ages’ has been closely associated with Universal Design, which is based on this belief . The approach can be extended from the design of houses, appliances, furniture and home utensils to neighbourhoods in which different generational groups meet, interact and negotiate shared use of their environment. This is another way to enhance social and emotional understanding between age groups, increase harmony, and promote sharing.

[3] www.generationsofhope.org

[4] http://www.communitiesforallages.org

[5] Biggs, S. and Carr, A. (2016) Age Friendliness, Childhood, and Dementia: Toward Generationally Intelligent Environments. In Moulaert, T. and Garon, S. (Editors) Age-Friendly Cities and Communities in International Comparison: Political Lessons, Scientific Avenues, and Democratic Issues. Springer International Publishing, Switzerland.

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NORCs- what are they and how can they be useful?

Judith Davey

07/04/17

I tell people that I live in a NORC, but it looks just like a high-rise apartment building. It might not strictly fit the definition of a NORC, but it is a good conversation-opener.

A naturally occurring retirement community, or NORC (rhymes with “fork”), is a term used to describe a community/neighbourhood/residential building or area that has a large proportion of older residents (over 60 or 65) but was not specifically planned or designed to meet the needs of seniors living independently. NORCs may develop in three different ways:

• Ageing in place: people moved into a community/neighbourhood/residential building or area when they were younger and stayed there as they aged (this is the case for several people where I live);
• Emigration: older people remain in place as younger residents move out (this would apply to many suburbs in New Zealand);
• Immigration: older people move into an area, attracted by features which appeal to them as part of retirement living (climate, scenery, local amenities). In New Zealand, the Kapiti Coast, Tauranga and parts of North Auckland would be examples.
Retirement villages do not fit the definition as they do not occur naturally.

NORCS just emerge over the years, but can be identified by census figures on age structure. Once identified, these areas are likely to develop age-friendly features consistent with the needs and aspirations of the residents. These could be hobby, sporting and other groups, based on interests. They could be support services for people who need them, whether commercial or linked to government-provided health and welfare services. They could be age-friendly features related to local planning – footpaths, road crossings, transport facilities. Now that the New Zealand government, through the Office for Seniors, is showing an interest in the global Age Friendly Cities and Communities movement, perhaps some local NORCS could become pilot areas for the AFCC approach.

An alternative and more formal definition of a NORC is found in the USA. The Naturally Occurring Retirement Community-Supportive Services Program (NORC-SSP) developed in 1985 in New York City. These NORCs are buildings or neighbourhoods that have been retro-fitted to provide services for older people. They are often a single residential estate or tower block. These NORCs provide health care management and prevention programmes; social care services; help with transport, education and recreation on-site or close by. Each NORC will provide a special range of services linked to the needs of their residents; they may have a special ethnic or cultural flavour. For example, Jewish Home in New York, has a 160+ year history of serving Jewish elders and now has partnerships with several NORC communities to provide health and social services to tenants in apartment buildings.

The first NORC programme in the USA was established in 1986 at Penn South Houses, a ten-building 2,800-unit moderate-income housing cooperative in New York City. Since then, the model has spread to more than 25 states across the country. In recent research NORC-SSPs have been found to contribute to social connections, community participation and service access, and have helped older people to age in place, when this has been their preference.

All American NORCs have the aim of promoting older people’s access to services and reducing social isolation. They are often partnerships between housing entities and their residents, health and social service providers, government agencies, philanthropic organisations, and other community organisations. NORC residents are usually an essential part of the programme, contributing to development, governance, and service provision as volunteers (along the line of the “age-friendly” philosophy). Clearly this approach would work best in areas of social or cooperative housing.
Other NORCS may take the form of membership-based “villages”, as I mentioned in a previous blog.

Some NORC-SSPs, at least in New York, have been able to advocate successfully for funding from state and local governments. But lack of, or insufficient, funding makes such developments vulnerable, and, outside New York, many NORC-SSPs have proved relatively unstable as funding opportunities change and/or are withdrawn.
There are obviously NORCs and NORCs and different views of their success. One comment- “Some of the best retirement communities occur naturally.” Another – “NORCs can take many forms, ranging from vibrant communities that encourage seniors to stay engaged to sad places where the elderly live in isolation, fearful that they’ll die alone.” What makes the difference? Perhaps having the array of services which best fits the local population is the key to success and sustainability.

Little seems to be known about NORCs in New Zealand along the lines of the overseas literature, but they certainly exist. Could they be the basis for age-friendly communities as promulgated by the World Health Organisation? What kind of organisation and funding would be suitable here? How could they contribute to the wellbeing of older people?

 


Bedney, B., Schimmel, D. and Goldberg, R. (2007). Rethinking aging in place: Exploring the impact of NORC supportive service programs on older adult participants. Paper presented at the Joint Conference of the American Society on Aging and the National Council on Aging, March 7–10, Chicago.
Bedney et al. 2007

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A Wider Range of Housing Choices needed for Older People- Examples from overseas

Judith Davey

24/3/17

Housing plays a variety of roles in the lives and wellbeing of older people. Inadequate living conditions lead to increased stress levels, social isolation, poor health and a higher risk of illness and injury.  Older people need to be able to exercise choices over their housing options and to seek out the types of housing which best suit their circumstances. But the range of choices in New Zealand is not very extensive.

Perhaps we need to consider new approaches. What about co-operative housing, shared housing, accessory units (“granny-flats”), co-housing and intergenerational housing?  Here are a few examples of innovative housing options, mostly from the USA, which I have recently come across in the literature.

Senior “co-housing” is a way for a group of people to get together and create a custom-designed neighbourhood and types of housing directly tailored to their needs and aspirations. Such developments typically have shared amenities such as a library, guest rooms, community gardens and recreational facilities, as well as individual living units. The model originated in Denmark and now co-housing for older people, or with a multi-generational focus, is found throughout Europe.

The first three senior co-housing communities in the USA opened in 2006[1]. In Glacier Circle, California, twelve friends who had known one another for thirty years built a townhouse-style community. Elderspirit, in Virginia, is a residential community formed around later-life spirituality. It has fourteen owner-occupied cottages, and fifteen rental apartments. Silver Sage is an upscale community of sixteen duplexes and attached homes in Colorado.

The Burbank Senior Artists’ Colony arose out of the collaborative efforts of a private developer, a non-profit arts programme and an affordable housing provider. It includes 147 rental apartments offering independent living (70% at market rate; 30% “affordable” rentals) in a creative, art-inspired environment. It has a theatre and art studios. Residents host arts events for their neighbourhood, present live entertainment and opportunities to work in the studios.

These examples fit the “village” model, where older people develop membership associations, often within an existing residential area, that provide supportive services and social activities.[2] Village members pay annual dues and receive access to services, such as weekly grocery shopping trips; referrals and discounts for outside services (e.g. home repairs); social and educational activities, and opportunities to participate in governance and peer support. It is a kind of “do-it-yourself” retirement village. Most of the New Zealand equivalents – retirement villages – are commercial enterprises with varying degrees of consumer input. Many are part of “chains”; others include individual private sector developments and villages in the charitable and religious sector, but the same comment will apply.

Providing affordable housing for low-income older renters in high-cost areas is the aim of Senior Housing Solutions (SHS), a non-profit group in California. The group purchases and remodels single family homes to provide affordable group rental housing. The design template for each house includes five private bedrooms, a shared kitchen and living space and landscaped front and back areas. By blending multiple funding programmes and rental income, SHS meets capital and operating expenses, and provides caseworker support.[3]

The Human Investment Project (HIP) Housing in California, is one of more than 100 home-share programmes in the United States that bring together home providers and home seekers through a “match-up” service. It can match homeowners – mostly older people – with home seekers who pay rent. It can also set up service exchanges that give home seekers a place to live for free in return for providing services to the homeowner.

The Homeshare Australia and New Zealand Alliance Inc. (HANZA) was established in 2006. Its web-site says that currently there are no active programmes in New Zealand but expressions of interest would be welcomed.[4] Presbyterian Support (Enliven) East Coast apparently has a scheme in Hawke’s Bay which is apparently proving a success with older home owners and younger homesharers.[5]

How could these models be used to expand housing choices for older people in New Zealand? Who could take the initiative? What are the prospects for partnership between public, private and voluntary sector organisations? Changes in the housing environment suggest that there is some urgency to address these questions. Will housing affordability become an increasing barrier to choice? The fall in home ownership will soon work through to affect the older age groups. Will current rental stock meet future requirements?

 

[1] From Kennedy, C. (2010) The City of 2050-An Age-Friendly, Vibrant, Intergenerational Community. Generations, 34,4, p.70-75.

[2] I will say more about such “NORCs” – Naturally Occuring Retirement Communities – in another blog.

[3] Abbeyfield is a New Zealand example of this type of housing.

[4] homeshare.org.au

[5] presbyterian.org.nz/node/3204/view

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Age friendliness in action – practical assistance for older people in New York City

Judith Davey

27/2/17

It is hard to imagine that any city in New Zealand could learn from New York, USA. Its population is over 20 million, five times that of the whole of this country. But it provides some great ideas about age-friendliness – a topic I have been working on recently.

In 2007 the New York City Council, working with the New York Academy of Medicine, carried out community consultations, focus groups, interviews, and surveys, in 14 neighbourhoods and in six languages. There were round table discussions with business, housing, social services, health, transport and education experts. This produced Toward an Age-friendly City: A Findings Report (Goldman et al. 2016). [1]

The Age-Friendly New York City Commission was set up and an action plan drafted. The guiding principles are well worth noting:

  • An ageing population is an opportunity, not a crisis;
  • Older people must be involved in all phases of problem identification and resolution;
  • Initiatives should address the full diversity of the older population – their functional capacity, economic resources, age, gender and ethnicity;
  • Initiatives should be grounded in evidence;
  • All sectors (public and private) must be engaged in developing solutions to eliminate barriers to older adults’ full participation in society.

Here are examples of some practical measures to assist active ageing in New York City.

  • Streets – Older people reported significant barriers to pedestrian safety including inadequate street crossing times, poorly maintained sidewalks and lack of seating. One person said, “I age every time I have to cross the street.” The NYC Department of Transportation, through its Safe Streets for Seniors Program evaluates conditions in areas with high rates of senior pedestrian fatalities or injuries and implements mitigation measures. These include extending pedestrian crossing times, constructing pedestrian safety islands, widening curbs and medians, narrowing roadways, and installing new stop controls and signals. These changes have made streets safer for all New Yorkers.
  • Walkability – The Department of Transportation is installing 1,500 benches around the city to improve walkability. These are particularly near senior centres and housing; hospitals and health centres; shopping districts and municipal facilities, such as public libraries. Individuals and communities can request a bench in a specific location. Older people report having made new social ties with people who frequent the same benches at the same times.
  • Bus Shelters – The Department of Transportation replaced almost all pre-existing bus shelters and installed 4,000 additional ones at locations identified by older people, with seating and transparent walls. These shelters are paid for by advertisements on their sides. As a result older people can feel safe and independent walking their streets and going about their daily lives. It also serves to decrease social isolation as people get out more.
  • Transport – Through a partnership with the Department of Education, school buses can be used by senior centres to transport older people on shopping trips when buses are not needed for children.
  • Recreation – When discussing recreational opportunities, older people said they had not used public pools in decades because they felt uncomfortable among children and teenagers. The Department of Parks and Recreation piloted senior-only swim hours at one public pool, known as “Senior Splash.” The programme was so popular that it was expanded to 16 pools throughout the City and water aerobics instruction was added. An evaluation of this programme indicated that older people who participated in water aerobics had greater lower body strength and flexibility than those who did not.
  • Business – The Age-Friendly Local Business Pilot Project was launched in 2011. Businesses were approached, provided with a resource guide, and encouraged to carry out simple enhancements, such as offering chairs for older people. They were also given window decals so that older adults would know which businesses were age-friendly. A small study suggested that participating businesses had higher average cash receipts than similar non-participating businesses.
  • Professions – Age-Friendly New York City has also approached professional associations to encourage them to think about their work in new ways and to see population ageing as an opportunity for professional growth. Professions approached included architecture and design, law, pharmacy, library sciences, and urban planning. “Best Practices” brochures, were created in collaboration with professional associations and disseminated to members.

All great ideas – don’t you think?  What about it NZ?

[1] Information comes from Goldman, L., Owusu, S., Smith, C., Martens, D. and Lynch, M. (2016) Age-Friendly New York City: A Case Study. Chapter 9, pages 171-190 in Moulaert, T. and Garon, S.(Editors) (2016) Age-Friendly Cities and Communities in International Comparison: Political Lessons, Scientific Avenues, and Democratic Issues. Springer International Publishing, Switzerland.

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Ageing and Policy – how have attitudes changed?

Judith Davey

For 24/2/17

The book which is taking up a lot of my attention at the moment – Age-Friendly Cities and Communities in International Comparison – has a sub-title – Political Lessons, Scientific Avenues, and Democratic Issues. In the chapter contributed by Alan Walker, of the University of Manchester[1], he looks at how the view of ageing and older people has changed over the decades in the eyes of policy makers. He concentrates especially on Europe, but there is some relevance to New Zealand.

In what Walker calls the ‘golden age’ of welfare state construction following Second World War there were both positive and negative outcomes for older people. On the one hand government income support raised their living standards. There had been high levels of poverty in old age in most European countries in the 1950s and 1960s (one in three older people in the UK were classified as poor and one in five in Germany). But, on the other hand, older people became dependent in economic terms and this encouraged ageist stereotypes of old age as a period of poverty and frailty. To some extent this view of older people as passive recipients of pensions, albeit deserving ones, lingers, although it is now the label “greedy oldies” often creeps in. Walker maintains that institutional ageism and a negative social construction of old age remains.

All welfare states originated, to some extent, in provision for old age and public pension systems. New Zealand was an early starter. A means-tested pension for people 65 years and older was introduced in 1898. A universal (not means-tested) superannuation from age 65 came in with the 1938 Social Security Act, which also lowered the age for the means-tested pension to 60. Retirement Income support now is the largest item of national social expenditures.

When there was compulsory retirement at the age of eligibility for pensions, the expectation was that older people would leave the labour force, exchange wages for pensions and disengage themselves from formal economic activity. So, suggests Walker, retirement operated as a process of social exclusion. This exclusion contributed to a popular perception of older people were politically, as well as economically, inactive. Age stereotypes, that portrayed older people as passive, acquiescent, and disinterested in social and political participation, were encouraged. At that time, however, there were fewer older people and they were less healthy than now.

Things began to change in the 1970s. Policy makers began to reject the welfare state consensus and to question the cost of population ageing, which was becoming clearer. Then, in the 1980s, came the rise of neoliberalism and more criticism of public welfare. Worries about the costs of pensions and long term care emerged. Rising affluence was bringing down the age of retirement and many countries had early retirement policies.  Neoliberal deflationary measures had led to unemployment and there was a (vain) hope that the places of retiring workers would be taken by the young unemployed whose numbers were growing rapidly. What happened was not job substitution but job destruction, given the costs of early retirement schemes. A ‘burden of ageing’ and ‘ageing crisis’ discourse developed among policy-makers and in many countries there were reductions in retirement income support. Much of the recent history of superannuation in New Zealand has been attempts to cut back on Muldoon’s generous National Superannuation of the late 1970s.

But something else was developing. Social movements of the 1970s – human rights, feminism, Maori sovereignty – involved older people. Better welfare services meant that people were not only surviving longer but, doing so in better health. The negative impacts of the changes in economic and political ideology had a mobilising effect and led to protests against cuts in pensions, health and social services. Policy makers in several countries, including New Zealand, have responded to this by setting up advisory boards on ageing. Non-governmental organizations, like Grey Power and Age Concern, have emerged to advocate for older people.

These new social movements of civil society emphasised human rights, participation and social inclusion and fiercely opposed all forms of age discrimination. As neoliberal “market-driven” policy took over, we saw the emergence of the ‘older consumer’ and the ‘silver economy’. Older people who are more affluent than their forebears, are asserting themselves as consumers and as active participants in many spheres of life. “Active ageing” has become the theme and has become part of policy. The thinking behind this new approach is expressed perfectly in the WHO dictum “years have been added to life now we must add life to years”. This is a long way from the perception of older people as deserving, but poor and dependent. But have we got rid of age discrimination?

[1] Walker, A. (2016) Population Ageing from a Global and Theoretical Perspective: European Lessons on Active Ageing. p. 47-64 in Moulaert, T. and  Garon, S. (Editors)(2016) Age-Friendly Cities and Communities in ternational Comparison Political Lessons, Scientific Avenues, and Democratic Issues. Springer International Publishing Switzerland.

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Friendly urban neighbourhoods for people with dementia – and others

Judith Davey

For 10/2/17

I have been doing some work lately on Age-Friendly Cities and Communities.  A sub-set of these are dementia-friendly environments. We have all heard about the likely increase in numbers of people with dementia as our population ages, but it is also clear that what might be good for this group will probably also be good for older people in general. An article in the Journal of Urban Design gave me a lot to think about and things to look out for as I walk around Wellington. [1]

To live at home successfully, people with dementia, not only need medical and social support but also outside environments where they can feel safe and comfortable. As the researchers say:

The spatial disorientation and short‐term memory problems experienced by the majority of older people with dementia can make each trip around the local neighbourhood a journey into the unknown. They are at great risk either of losing their way when they go out or of becoming housebound through a fear of becoming lost. Yet the social, psychological and physical benefits of confident and proficient use of the outdoor environment for people with dementia are numerous.

And the same probably goes for many of us!

The authors realised the necessity of seeking information directly from people with dementia. They interviewed people from this group, accompanied them on walks and analysed the characteristics of the local environment.

Some of the participants did lose their way on the walks, but some did not, mainly because they stayed in familiar territory and they had visual clues to help them. Losing their way happened most frequently at road crossings and junctions, when following a less familiar route, or when they lost concentration, for example when they were daydreaming or distracted by a loud noise. Participants were often startled by passing heavy vehicles or children shouting and especially by emergency vehicle sirens, causing them to become confused and disoriented. Excessive information and uneven paving were two additional causes of bewilderment. The researchers concluded that older people with dementia rely on the “legibility” of their local neighbourhoods. What does this mean?

Street layouts. Most participants showed a preference for short, narrow and gently winding streets rather than long, wide or straight streets. The former were more interesting, gave better sight lines and therefore were helpful in maintaining concentration. Streets on grid patterns had the potential to cause a loss of concentration and disorientation with too many cross roads and sharp blind corners.

Building form and style.  Participants found streets with varied architectural features more interesting than those with repetitive forms in buildings and street lay-out. Different shapes, features, colours and contrasts, such as varying roof lines, front doors, windows and gardens, were all useful tools for successful navigationt. Although participants were most likely to lose their way at road crossings and places with poor visual access, many also became disoriented on streets identical to neighbouring ones, with identical buildings and few distinguishing features.

People with dementia preferred vibrant, informal open spaces with plenty of activity, such as squares surrounded by shops, cafés and offices, and parks containing tennis courts, children’s play areas, boating ponds and so on. These were preferred to empty, open expanses of ground or formal green open spaces. The former provide interest and environmental cues which helped them to find their way around. They also present a more welcoming and safer environment.

Signage. Too many signs cause confusion. Where they are necessary they should contain simple, explicit information with realistic symbols. Participants preferred plain signs with large, dark lettering on a light background. Advertising and shop boards were considered to be extraneous and hazardous clutter. Signs perpendicular to the wall were considered very useful as they are visible from a distance. The post office sign is a particularly good example, being well established, familiar and encountered regularly.  What would be the New Zealand equivalent?

Environmental “cues”. The most useful environmental cues are practical and decorative items, such as clocks, hanging baskets and pot plants strategically placed at decision points and places where visual access ends. The types of landmarks which participants used included civic buildings, such as churches, libraries and town halls; distinctive structures, such as clocks and public art; places of activity, such as mixed‐use squares, parks and playgrounds; places or buildings of personal significance, such as a previous workplace, doctor’s surgery, a favourite cafe and so on. They could also include aesthetic features, such as attractive gardens, trees or planters and street furniture, including telephone and letter boxes, public seating and bus shelters. When such “clues” were encountered regularly they added to the “legibility” of the neighbourhood and were useful for wayfinding, particularly when located at important decision points.

When new developments are planned or existing areas regenerated, these design suggestion could usefully be incorporated. They would help to ameliorate the sense of isolation and anxiety experienced by many older people, with or without dementia, and people with other cognitive impairments, such learning difficulties, Down’s syndrome or brain damage. Other beneficiaries would be children and foreign visitors. An outdoor environment that people are able to confidently understand, navigate and use, regardless of age or circumstance, should be the ultimate goal of inclusive urban design.

[1] L Mitchell E Burton  & S Raman (2004) Dementia‐friendly cities: designing intelligible neighbourhoods for life. Journal of Urban Design  Volume 9, Issue 1, pages 89-101.

 

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New policy statement on the health of older people – the “Healthy Ageing Strategy”

Judith Davey

27/01/17

Drafts of the Health of Older People Strategy, an update of the 2002 document, have been around for a while and there have been numerous consultation initiatives, which you may have heard of. Fairly late in the piece the name was changed to the “Healthy Ageing Strategy (HAS)” – a change which Minister Sam Lotu-liga claims as his initiative in his foreword to the strategy document. He states that this name change recognises the diversity of older people and the aim to maximise health and wellbeing throughout people’s older years. I am not sure I quite see the logic in this, but the new strategy certainly does recognise diversity and takes a broad view on wellbeing – well beyond the usual narrow definitions of health as based on medical interventions and hospital services. It has a strong focus on prevention, wellness and support for independence. It emphasises equity and giving attention to the most vulnerable.

Looking wider
In the international sphere, New Zealand is a signatory to the World Health Global Strategy on Ageing and Health 2016-2020.  Among its objectives are developing age-friendly environments (more about that in later blogs), sustainable and equitable systems for care and a commitment to action on healthy ageing. WHO defines healthy ageing as “the process of developing and maintaining functional ability which enables wellbeing in older age”.

The Healthy Ageing Strategy links with the overall New Zealand Health Strategy, released in 2016, the Disability Strategy and the Positive Ageing Strategy. The latter may also be receiving a make-over this year, not before time, and could build on many of the actions proposed by HAS.

Another aspect of a wider view is the strategy’s emphasis on a life-course approach, recognising how influences from childhood and through adult life affect health outcomes in later life. These include our upbringing and how healthily we live – a strong form of prevention. Environmental factors – housing, workplaces, discrimination and the quality of family life are also important.

Achieving equity
WHO defines equity as “the absence of avoidable or remediable differences among groups of people whether those groups are defined socially, economically, demographically or geographically” Persistent health inequities in New Zealand are recognised, affecting Maori, Pacific peoples, migrant and refugee communities, people with disabilities and mental health conditions and addictions, and people with low incomes. Achieving equity means understanding and removing barriers that prevent groups from experiencing equitable health outcomes, which will include enabling access to health services and acknowledging cultural preferences. Also important is enabling equal opportunities to raise capacities and functional abilities.

Action plan
The next step is to develop an implementation plan for work over the next ten years. This will involve both the health and social systems, as well as a wide variety of service providers, NGOs, communities and older people themselves.

The strategy sets out and prioritises actions, some to be achieved in the next two years, and nominates lead partners for implementation. Here are a few examples which caught my eye-

  • Promote the concept of age-friendly communities – led by Office for Seniors.
  • Increase the availability of strength and balance programmes in homes and community settings (oriented towards falls prevention) – led by ACC.
  • Review the Green Prescription programme and improve its use by older people – led by Ministry of Health.
  • Promote volunteering, networking and paid work among older people as a means to support their sense of wellbeing and social connection – led by Ministry of Social Development.
  • Support older people’s uptake of technologies for communication with health providers and their family and whanau (application in rural and remote areas specified) – led by DHBs.
  • Develop a range of strategies to improve recruitment and retention of those working in aged care – led by Ministry of Health.
  • Explore options for aged residential care facilities to become providers of a wider range of services for older people such as restorative care, including non-residents – led by DHBs.
  • Improve the support for informal carers, including various types of respite care, guidance and information and training – led by Ministry of Social Development.

A consummation devoutly to be wished, as Shakespeare wrote! Watch this space! The HAS is certainly broad and ambitious. I hope I have encouraged you to take a look, if you have not done so already. It has something for everybody and plenty of good intentions. We should wish it every success.

Download the Strategy

Foot note: Age Concern New Zealand proposed the name “Healthy Ageing Strategy” as part of their submission and feedback during the consultation process.

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