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Unlocking the benefits of age-friendly cities

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. 

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”

FOR MORE INFORMATION

Email Stefanie Buckner at:

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