A Global Movement Toward Lifelong Livability
Around the world, populations are aging, making the creation of supportive environments an urgent priority. The concept of an age-friendly designation originated from the World Health Organization's (WHO) Global Network for Age-Friendly Cities and Communities, launched in 2006. The initiative was designed to help cities adapt to their aging demographics by optimizing environments to promote the health, safety, and inclusion of older people. Since then, the movement has expanded to include specific designations for health systems, workplaces, and public health entities, each with its own criteria and framework for success.
The WHO's Eight Domains of Livability
At the heart of a community's age-friendly designation are the eight domains of livability identified by the WHO. These domains provide a comprehensive framework for assessing and improving the physical and social environments of a community to support active aging. To earn recognition, a community must demonstrate efforts to improve in each area:
1. Outdoor Spaces and Buildings
This domain focuses on creating public spaces that are safe, clean, accessible, and enjoyable for people of all ages. This includes well-maintained sidewalks, public seating, accessible public buildings and restrooms, and green spaces like parks with easy access for those with mobility aids.
2. Transportation
Accessible and affordable transportation is critical for maintaining independence and social connections. An age-friendly community provides reliable public transit, paratransit services, accessible vehicles, and safe pedestrian infrastructure, such as well-lit streets and visible crosswalks.
3. Housing
Ensuring a range of safe, affordable, and adaptable housing options allows older adults to age in place. This includes options for home modifications, different living arrangements, and affordable housing stock, which has positive economic impacts on the public and private sectors.
4. Social Participation
Opportunities for leisure, cultural activities, and social events are vital for mental and emotional well-being. Age-friendly communities support a wide range of social activities that are financially, culturally, and physically accessible, helping to combat social isolation.
5. Respect and Social Inclusion
This domain promotes the inclusion and active participation of all residents, challenging ageism and fostering positive, respectful attitudes toward older people. It often involves intergenerational programs and positive representations of aging in the media and public discourse.
6. Civic Participation and Employment
Age-friendly communities create opportunities for older adults to continue contributing through paid work or volunteering. This involves promoting age-friendly employment policies and advertising accessible volunteer roles.
7. Communication and Information
Timely and practical information must be accessible to everyone, regardless of physical or digital literacy. Communities work to ensure information is available in various formats and delivered through different channels to reach all residents.
8. Community Support and Health Services
Access to affordable and convenient community support and health services is essential. This can involve improving access to local healthcare, mental health support, and social services that address potential issues like financial instability.
Age-Friendly Health Systems: The 4Ms Framework
Beyond communities, the age-friendly designation is also a key marker for quality health care for older adults. The Institute for Healthcare Improvement (IHI) leads the Age-Friendly Health Systems initiative, which uses the "4Ms" Framework to guide evidence-based, high-quality care. The 4Ms are:
- What Matters: Aligning care with each older adult's specific health outcomes and care goals, including end-of-life wishes.
- Medication: Using age-appropriate medications that do not compromise mobility, mentation, or the patient's preferences.
- Mentation: Preventing, identifying, and managing dementia, depression, and delirium to promote overall mental health.
- Mobility: Ensuring older adults move safely each day to maintain function and prevent decline.
The Path to Designation: A Collaborative Process
Becoming age-friendly is a deliberate, multi-stage process that requires commitment from local leadership and community stakeholders. While specific steps vary by organization (like WHO or AARP), a common pathway involves:
- Commitment: The community's leadership, such as elected officials, formally commits to the age-friendly initiative.
- Assessment: A comprehensive community assessment is conducted, often through surveys and focus groups, to identify local needs, strengths, and challenges based on the WHO's eight domains.
- Action Plan: Based on the assessment, a strategic action plan with measurable goals and objectives is developed to address identified needs.
- Implementation: Partners from various sectors—government, business, non-profits, and residents—work together to deliver actions and initiatives.
- Evaluation: The community regularly evaluates its progress and reports its findings to maintain its designated status.
Comparison: Age-Friendly vs. Dementia-Friendly Communities
While related, age-friendly and dementia-friendly designations have different scopes. An age-friendly approach is broad, addressing the needs of older adults across all eight domains of livability. A dementia-friendly approach is more specialized, focusing specifically on supporting individuals living with dementia and their caregivers.
| Feature | Age-Friendly Community | Dementia-Friendly Community |
|---|---|---|
| Primary Focus | General well-being, active aging, and independence for all older adults. | Specific needs and challenges of people living with dementia and their families. |
| Key Domains | Addresses eight broad areas of livability (e.g., housing, transportation, social participation). | Addresses awareness, safety, accessibility, and support services tailored to cognitive impairment. |
| Examples | Adding public benches, providing affordable transport, promoting senior employment. | Educating businesses on interacting with those with cognitive issues, training first responders, creating memory cafes. |
| Goal | To create a supportive environment for aging across the lifespan. | To foster understanding and ensure people with dementia can remain active and included in community life. |
For more information on the foundational principles, visit the WHO Age-friendly cities and communities website.
Conclusion
Ultimately, an age-friendly designation signifies a public commitment to adapting a community's environment and services to support the health, independence, and social inclusion of people as they age. It is a proactive and transformative process that leads to tangible improvements, such as better transportation, accessible public spaces, and tailored health care. These changes not only benefit the growing senior population but also create more livable, resilient, and inclusive places for residents of all ages, demonstrating that a focus on healthy aging is an investment in the entire community's future.
