Unlocking the benefits of age-friendly cities

Source: RTM Jun/Jul 17

Stefanie Buckner, Calum Mattocks and Louise Lafortune from the Cambridge Institute of Public Health, alongside Melanie Rimmer from the School of Health and Related Research at the University of Sheffield, and Daniel Pope and Nigel Bruce from the University of Liverpool’s Institute of Psychology Health and Society, discuss the role of the health sector and other local stakeholders in creating environments to foster healthy ageing.

Health services at city and community levels have a critical role to play in local responses to population ageing. In a growing number of UK settings, collaborative efforts to create environments that foster healthy ageing are underway. Health sector representatives are natural key partners in such initiatives. Ensuring the effectiveness and efficiency of the latter relies on robust evaluation, which in turn calls for the right tool. 

The ageing of the UK population presents a public health challenge as well as an opportunity. Cities and communities are under pressure to adapt their built environments and their social and service infrastructures to changing priorities and to unprecedented levels of demand. At the same time, this demographic shift brings with it opportunities through the experience and energy of older people. There is a responsibility at the local level to both meet the needs and harness the potential of an ageing population. 

The World Health Organization’s (WHO) Age-Friendly Cities (AFC) framework is helpful to support cities and communities as they respond to their populations growing older: “An age-friendly city encourages active ageing by optimizing opportunities for health, participation and security in order to enhance quality of life as people age”. A growing number of urban settings in the UK are working to improve their age-friendliness, and several cities – including Manchester, Liverpool and Sheffield – have joined WHO’s Global Network of Age-Friendly Cities and Communities. Health services commonly play a leading role in these local collaborative approaches, and age-friendliness has become an explicit consideration for policy and commissioning decisions in many cities and communities. 

Stakeholders in age-friendly initiatives need to be confident that their investments will yield returns, and that adopting this approach will generate added value. Although a number of evaluation tools are available, two key issues need to be considered. First, robust evaluation of age-friendly initiatives needs to reflect the complexity of the systems under scrutiny, meaning the tools used need to be adaptable. Second, evaluation findings need to be owned by stakeholders in order to encourage follow-up action. This can be achieved through stakeholders assuming a central role in evaluation.

An evidence-based evaluation tool for age-friendly initiatives was developed by researchers from the National Institute for Health Research (NIHR) School for Public Health Research (SPHR). This tool identifies 10 areas in which data are required to assess age-friendliness. These include provision of services and facilities, and engagement of older adults as key ingredients in age-friendly approaches. In addition, the tool captures structures and processes that underlie AFC initiatives and shape their success – such as political support, leadership and governance arrangements, and resourcing. It thus complements existing assessment frameworks, including those developed by WHO, which emphasise delivery of specific activities, as well as involvement and experiences of older people. 

iStock 000003223740Large edit

Age-friendly evaluation case studies 

The evaluation tool has been designed for use by a local steering group comprising health service representatives alongside other stakeholders, including members of the public. It provides a framework for a process that begins with collating available information, collecting additional evidence where there are gaps, and analysing the data. Stakeholders identify strengths to be harnessed and gaps to be addressed before formulating follow-on action. This process benefits from collaboration with external researchers, who can contribute expertise and act as a ‘critical friend’. 

As well as accommodating local age-friendly priorities, the evaluation tool allows the steering group to work with evidence that is most appropriate in a specific context. This is illustrated by the different settings in which it has been applied so far. The first of these was a city in northern England in which falls among older people were identified as a public health priority. In addition to the city’s overall AFC initiative, evaluation focused on falls as a case study. This highlighted leadership by the NHS on falls-related work and collaboration with local partners as strengths. At the same time, it emphasised the need for more detailed data on the precise locations and causes of falls, and more consistent recording. 

In a second setting, the steering group chose the local Dementia Friendly Community initiative for evaluation. This work drew attention to the critical contributions to the evaluation of NHS stakeholders, who provided strategic oversight of dementia-related initiatives and supplied data. 

Finally, the tool was applied in one of the 10 NHS Healthy New Towns. Through a steering group, it informed the local Design Code to ensure that the latter can guide the development of a town that enables healthy ageing. An early output of this is the decision to install more public seating than originally planned.  

While cities and communities are shaped by local action, wider national (such as funding policy) and international influences (such as migration) also play an important role. It is the task of stakeholders in the health and other sectors to create environments where local policies and actions interact with higher-level ones in such a way as to foster healthy ageing. The evaluation tool developed through the SPHR provides them with an evidence-based means to achieve this by enabling them to identify priorities for action and track progress. 

The study was funded by the NIHR School for Public Health Research in the UK as part of the Ageing Well Programme (2012-2017). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

“An age-friendly city encourages active ageing by optimizing opportunities for health, participation and security in order to enhance quality of life as people age”


Email Stefanie Buckner at:




There are no comments. Why not be the first?

Add your comment


national health executive tv

more videos >

latest healthcare news

Lord Kerslake quits as trust chair in protest against NHS underfunding

11/12/2017Lord Kerslake quits as trust chair in protest against NHS underfunding

Lord Kerslake has resigned as the chairman of a major hospital trust in London in protest against historic underfunding in the NHS. The respect... more >
CQC praises ‘proactive’ Hartlepool services in care integration review

08/12/2017CQC praises ‘proactive’ Hartlepool services in care integration review

The CQC had praise for the health and care system in Hartlepool as it continued its programme of 20 targeted reviews of integrated care. The... more >
Government launches inquiry into Ian Paterson case

08/12/2017Government launches inquiry into Ian Paterson case

A national inquiry has been launched into the malpractice of Ian Paterson. Earlier this year the breast surgeon was sentenced to 20 years in pri... more >
681 149x260 NHE Subscribe button

the scalpel's daily blog

Ten lessons to support new care models locally

29/11/2017Ten lessons to support new care models locally

Anna Starling, policy fellow at the Health Foundation, offers the top 10 lessons for local leaders seeking to make systematic improvements across services, all based on first-hand accounts from vanguard officials. Redesigning health and social care services across traditional boundaries is not easy. Making change in complex environments, with differing professional viewpoints and varying organisational priorities while getting on with t... more >
read more blog posts from 'the scalpel' >


Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >
Tackling infection prevention locally

04/10/2017Tackling infection prevention locally

Dr Emma Burnett, a lecturer and researcher in infection prevention at the University of Dundee’s School of Nursing and Midwifery and a boar... more >
Scan4Safety: benefits across the whole supply chain

02/10/2017Scan4Safety: benefits across the whole supply chain

NHE interviews Gillian Fox, head of eProcurement (Scan4Safety) programme at NHS Supply Chain. How has the Scan4Safety initiative evolved sin... more >
Simon Stevens: A hunger for innovation

25/09/2017Simon Stevens: A hunger for innovation

Simon Stevens, chief executive of NHS England, knows that the health service is already a world leader when it comes to medical advances – ... more >

last word

The Refugee Doctor Initiative

The Refugee Doctor Initiative

Terry John, co-chair of the BMA & BDA Refugee Doctors and Dentists Liaison Group and chair of the union’s international committee, talks about a brilliant initiative that is proving mut... more > more last word articles >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

health service focus

Release full market value against surplus and decommissioned assets

28/11/2017Release full market value against surplus and decommissioned assets

Advertisement feature: Oliver Pearson, sal... more >
Operation Barcode: selecting technology to succeed

22/11/2017Operation Barcode: selecting technology to succeed

The benefits of Scan4Safety have been widely ... more >