Age-Friendly Cities: A Social Work Perspective

THE GLOBAL MOVEMENT

Anyone who has watched an ancient woman make her way along a city crosswalk well after the “don't walk” sign has begun flashing is aware of the hazards of growing old in an urban environment. Age slows us down and makes us vulnerable to a range of assaults, from isolation to fast traffic, from fear of crime to air pollution. Recognizing this and the increasing age and urbanization of human life on earth, the World Health Organization (WHO; 2007) has called on cities to become more age-friendly as “ … a necessary and logical response to promote the wellbeing and contributions of older urban residents and keep cities thriving” (p. 4). Here I will briefly explore the progress of this global movement and reflect on the potential contributions of social workers.

Urban Hazards and Older Adults

Cities are particularly hazardous for older adults. In many cities, for instance, an older pedestrian risks death or injury simply crossing the street. In the European Union the highest pedestrian fatality rates are observed among those 65 and older. In 2006 the fatality rate for pedestrians aged 80 or over was 10 times the rate for children, and in Greece, Italy, and France over half of pedestrian fatalities were older adults (European Road Safety Observatory, n.d.). Meanwhile, in New Jersey, New York, and Connecticut, pedestrians over 60 years old are more than twice as likely to be killed as younger walkers (Tri-State Transportation Campaign, 2012). A number of sources have concluded that crossing signals simply do not allow sufficient time for older adults (particularly those over 80 years of age) to comfortably get across the street (Romero-Ortuno, Cogan, Cunningham, & Kenny, 2009, Tri-State Transportation Campaign, 2012).

Fear of crime can be debilitating for urban elders. Despite experiencing the lowest rate of violent victimization in the United States, many older Americans report significant fear of crime; a concern that can exacerbate their isolation and diminish their quality of life (Truman, 2011). High rates of crime in disadvantaged neighborhoods certainly contribute to this fear, as do dark, isolated, neglected streets and subways. This has led some to suggest that modifications in the physical environment (like street lighting, surveillance cameras, or graffiti removal) might reduce fear of crime. But, as Rachel Pain (2000) pointed out, “social relations operating in particular spaces and places are more integral to fear of crime than the physical character of particular environments” (p. 370).

When city pollution levels in the United States exceed federal standards, local governments warn “the very young and the very old” to stay indoors. This is good advice because older adults are especially susceptible to the health effects of air pollution, which include asthma, pneumonia, heart attacks, lung damage, and (perhaps) cognitive impairment (Shumake, Sacks, Lee, & Johns, 2013; Weuve et al., 2012). Indeed, some suggest that older adults should take further measures, such as using HEPA filtration to reduce exposure to airborne pollutants (Ailshire, 2012).

Of course, cities offer important advantages to older adults, including cultural, religious, and educational programs, public services, health care, and amenities like pubs, cafés, shops, libraries, museums, and parks. Apart from that, most elders have strong attachments to their neighborhoods and communities. Most will remain and cope with the hazards of urban living, and this is where the age-friendly cities movement comes in.

WHO “Age-Friendly Cities” Initiatives

The age-friendly cities movement has its origins in the notion of active aging, introduced in 1999, the United Nations’ Year of Older People. The active aging framework has been incorporated in the policies of several nations (including the United Kingdom, Australia, New Zealand, United States, Norway, Japan, Singapore, and others) and the WHO has expanded the concept beyond labor force participation or physical activity, to include the idea that older people should have opportunities to participate in the “social, economic, cultural, spiritual, and civic affairs” (WHO, n.d.-b) of their communities. This naturally led to the possibility that modifications in the social and physical environment might promote active ageing.

In 2006, the WHO launched the age-friendly cities initiative. Noting that “older people are the ultimate experts on their own lives” (p. 7), the WHO (2007) and its partners held 158 focus groups in 33 cities across the globe. A total of 1,485 older adults participated in discussions designed to give a comprehensive assessment of their cities’ age-friendliness. Eight topics were addressed: outdoor spaces and buildings, transportation, housing, respect and social inclusion, social participation, civic participation and employment, communication and information, and community support and health.

Results were presented as a comprehensive list of 88 features that represent a “universal standard for an age-friendly city” (World Health Organization, 2007, p. 11). The standard may be primarily aspirational. Some items in the WHO (2007) checklist include:

•	“Pedestrian-friendly walkways are free from obstructions, have a smooth surface, have public toilets and can be easily accessed.” (p. 18)
•	“Public transportation is affordable to all older people.” (p. 28)
•	“Older people are comfortable in their housing environment.” (p. 37)
•	“Organizations make efforts to engage isolated seniors through, for example, personal visits or telephone calls.” (p. 44)
•	“Older people are recognized by the community for their past as well as their present contributions.” (p. 50)
•	“Administrative and service personnel treat older people with respect and sensitivity.” (p. 71)

Still, 134 cities have signed on to these aspirations. The WHO established a Global Network that includes cities in 21 countries ranging from Andorra to the United States (see Table 1 for a list).

TABLE 1  Cities in WHO Global Network of Age-Friendly Cities (July 2013)

Country	Cities
Andorra	Andorra la Vella
Argentina	La Plata
Australia	Boroondara, Canberra, Melville, Rockingham, Unley, Warmambool,
Belgium	Brussels
Canada	Edmonton, Hearst, Kingston, London, Noelville, Ottawa, Port Colborne, Portage La Prairie, Saanich, Sault Sainte Marie, Thunder Bay, Verner, Waterloo, Welland, Windsor
China	Qiqihaer
Finland	Tampere
India	Kolkata
Ireland	Kildare, Kilkenny, Louth
Israel	Haifa
Japan	Akita
Mexico	San Agustin Tlaxiaca
Portugal	Alfandega da Fé, Alpiarça, Alter do Chão, Campo Maior, Castro Marim, Esposende,Fátima, Funchal, Gondomar, Grândola, Horta, Açores, Maia, Mesão Frio, Odivelas, Oliveira de Azeméis, Ponte de Sôr, Porto, Póvoa de Lanhoso, Setubal, Torres Vedras
Russian Federation	Agidel, Baymak, Belebey, Beloretsk, Birsk, Blagoveschensk, Chishmy, Davlekanovo, Dyurtyuly, Ishimbai, Kumertau, Meleuz, Neftekamsk, Oktyabrsky, Salavat, Sibai, Sterlitamak, Tuymazy, Uchaly, Ufa
Slovenia	Celje, Ivančna Gorica, Kobarid, Kostel, Ljubljana, Maribor, Ravne na Koroškem, Ruše, Velenje
Spain	Almendralejo, Barcelona, Bilbao, Donostia-San Sebastiàn, Las Rozas de Madrid, Llíria, Los Santos de Maimona, Manresa, Mata de Alcántara, Mérida, Oliva de la Frontera, Ourense, Santander, Tres Cantos, Vic, Vitoria-Gasteiz, Zaragoza
Sri Lanka	Moneregala District
Switzerland	Geneva
United Kingdom	Brighton and Hove, Manchester
United States	Austin, Bowling Green, Brookline, Chemung County, Chicago, Des Moines, Los Altos, Macon-Bibb County, New York City, Philadelphia, Portland, Roseville, Town of Los Altos Hills, Washington, Wichita
Source. WHO (n.d.-a).

In the United States, AARP serves as gatekeeper to the global network, which includes 15 U.S. cities as of this writing (AARP, n.d.). Like Geneva (home to WHO headquarters), most of the U.S. cities use a generic “check back soon” message on the WHO “Age-Friendly World” website to describe the progress of their efforts. A summary of city reports is provided in Table 2. New York City describes a well-developed campaign, including an assessment conducted by the New York Academy of Medicine (2008) that resulted in 59 commitments enacted by city government. One was formation of an age-friendly commission with members from public and private sector organizations to focus on businesses (both as workplaces and retail environments), college and universities, and neighborhoods. New York's accomplishments include improvements to the physical environment with the addition of 3,000 new “age-friendly” bus shelters and 1,000 new “age-friendly” benches.

TABLE 2  U.S. Cities on WHO Global Network (July 2013)

City	Status
Austin, TX	No report provided, instruction to “Check back soon”
Bowling Green, KY	No report provided, instruction to “Check back soon”
Brookline, MA	Plans to disseminate information to older residents on resources available to them; exploring other initiatives
Chemung County, NY	No report provided, instruction to “Check back soon”
Chicago, IL	Organizing to conduct assessment
Des Moines, IA	Planning has begun. Organized work groups chaired by volunteers (AARP is collaborating)
Los Altos, CA	Conducted a survey in 2011
Macon-Bibb County, GA	No report provided, instruction to “Check back soon”
New York City, NY	59 commitments: benches, bus shelters, age-friendly retail initiative, college & university programs, age-friendly swimming pools, Aging Improvement Districts
Philadelphia, PA	No report provided, instruction to “Check back soon”
Portland, OR	First US city to join, conducted assessment, developed action plan and engaged in dialogue
Roseville, CA	No report provided, instruction to “Check back soon”
Town of Los Altos Hills, CA	See Los Altos, above
Washington, DC	No report provided, instruction to “Check back soon”
Wichita, KS	No report provided, instruction to “Check back soon”
Source. WHO (n.d.-a).

Enabling Older City-Dwellers

The WHO initiative represents a top-down approach, in which policy-makers and gerontological specialists lead the change efforts (Lui, Everingham, Warburton, Cuthill, & Bartlett, 2009). Bottom-up approaches focus on the development of governance processes that involve older adults in planning and decision making on community issues that affect them. Among these is the CALL-ME study conducted in four disadvantaged neighborhoods of Manchester, England. In each community, older residents were engaged in setting a change agenda and in developing, implementing, and monitoring the action plan. Together, they transformed a vacant lot into a “community peace garden” and developed arts-based activities for socially isolated seniors (Buffel, Phillipson, & Scharf, 2012). Another bottom-up effort is the Calgary Elder Friendly Communities project, which enabled Canadian seniors to define and lead community development initiatives in their neighborhoods (Lui et al., 2009). These initiatives included creation of intergenerational programs in which school-age children help seniors with snow removal, establishment of seniors’ columns in local newspapers, infrastructure improvements like post boxes in senior housing complexes, programs in which seniors teach others how to apply for government benefits, and an annual conference to discuss the concerns of older adults (Austin, McClelland, Sieppert. & Perrault, n.d.).

The dialogue about age-friendly communities is part of a broader paradigm shift in public discourse and policy on older adults. Described as “an antidote to the conception of old age as an inevitable period of withdrawal from social roles and relationships,” it recognizes the importance of social inclusion and civic engagement as well as the physical environment for the well-being of older adults (Liu et al., 2009, p. 119). Because of this, age-friendly community initiatives can bring social workers shoulder to shoulder with urban planners, geographers, architects, traffic engineers, and others to help build communities that support and enable lifelong citizenship.

As Andrew Scharlach (2011) explained, “social workers have an important role to play” in the discourse and initiatives for age-friendly communities. To the discourse we bring an ecological perspective on the interactions between older adults and their environments as well as a commitment to self-determination; to ensuring that elders have a say in matters that affect them. To the initiatives we bring a long tradition of community organizing and community development, as well as skills in policy analysis and advocacy.

If you have not already, I hope you will take the opportunity to become part this burgeoning movement. You might help your city join the WHO Global Network. Or you could tap into a U.S. initiative like AARP's Livable Communities, the AdvantAge Initiatives, Community AGEnda, Communities for All Ages, Community Innovations for Aging in Place, the NORC/JFNA National Aging in Place Initiative, Partners for Livable Communities, or the Village to Village Network. You could organize to reduce loneliness, prevent pedestrian fatalities, or improve the air quality in your community. Or, you might join forces with older adults and see where they lead you—perhaps to a peace garden or a bench in a local park.

INTRODUCTION TO THE ISSUE

This issue begins with Loriena A. Yancura's (2013) study of the unmet service needs of custodial grandparents. Where most studies use samples conveniently recruited from service providers, Yancura drew her sample from a public school district in Hawaii, thus her results offer a broader look at the needs of grandparents who fall through the cracks. Then Juyoung Park and her colleagues (2013) report on factors that inhibit or facilitate the use of nonpharmacological pain management among ethnically diverse older adults, noting the role social workers can plan in assisting with transportation. In our third offering, Jacqueline Corcoran and her colleagues (2013) provide a meta-synthesis of literature on older adults’ experiences with depression. Our next offering turns to long-term care facilities, as Sheryl Zimmerman and her colleagues (2013) examine the often-troubled relationships between family and staff in nursing homes and assisted living facilities in North Carolina. Our final article is published as part of the Practice Forum. In it, Paula R. Klemm and her colleagues (2013) in Delaware describe the difficulties faced and lessons learned by those operating a unique partnership between a nonprofit organization and a university. The issue closes with Donna Wang's (2013) thoughtful review of David Haber's 2010 publication, Health Promotion and Aging.