Good places for ageing in place: development of objective built environment measures for investigating links with older people's wellbeing

Abstract

BackgroundThere is renewed interest in the role of the built environment in public health. Relatively little research to date investigates its impact on healthy ageing. Ageing in place has been adopted as a key strategy for coping with the challenges of longevity. What is needed is a better understanding of how individual characteristics of older people's residential environments (from front door to wider neighbourhood) contribute to their wellbeing, in order to provide the basis for evidence-based housing/urban design and development of interventions. This research aimed to develop a tool to objectively measure a large range of built environment characteristics, as the basis for a preliminary study of potential relationships with a number of 'place-related' functional, emotional and social wellbeing constructs.MethodsThrough a review of urban design literature, design documents, and existing measures, a new tool, the NeDeCC (Neighbourhood Design Characteristics Checklist) was developed. It was piloted, refined, and its reliability validated through inter-rater tests. A range of place-related wellbeing constructs were identified and measured through interviews with 200 older people living in a wide variety of rural-urban environments and different types of housing in England. The NeDeCC was used to measure the residential environment of each participant, and significant bivariate relationships with wellbeing variables were identified.ResultsThe NeDeCC was found to have convincing face and construct validity and good inter-rater and test/retest reliability, though it would benefit from use of digital data sources such as Google Earth to eliminate the need for on-site survey. The significant relationships found in the study suggest that there may be characteristics of residential environments of potential relevance for older people's lives that have been overlooked in research to date, and that it may be worthwhile to question some of the assumptions about where and how older people want to live (e.g. villages seem to be positive). They also point to the importance of considering non-linear relationships.ConclusionsThe NeDeCC provides the basis for generation of evidence-based design guidance if it is used in prospective controlled studies or 'natural experiments' in the future. Ultimately, this will facilitate the creation of better places for ageing in place.

What can local authorities do to improve the social care-related quality of life of older adults living at home? Evidence from the Adult Social Care Survey

“…Older adults with declining health and functional status can be particularly limited in their mobility by barriers in their local area (Burton, Mitchell, & Stride, 2011). Previous studies have shown that the physical environment can have an impact on the independence and quality of life of older people living in the community (Burton et al, 2011;Lui, Everingham, Warburton, Cuthill, & Bartlett, 2009;Gilroy, 2008).…”

Bed of roses? The role of garden space in older people's well-being

“…Of particular relevance is its role in addressing the challenges of an ageing society (Burton et al, 2011), a worldwide phenomenon. To reduce the burden of care, policies now centre on facilitating independence in older age or allowing people to 'age in place'.…”

Linking COURAGE in Europe Built Environment instrument to the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY)

“…Much of the research in the area of the impact of built environment on health has concentrated on the links between neighbourhood characteristics and physical activity or obesity [8][9][10][11]. It is important to investigate the role of the built environment particularly in ageing population.…”

“…Older people spend more time in their home and community environments, barriers in environment can make more difficult dealing with declining health and functional status [8,12]. Recent studies have suggested that wellbeing in later life is closely related to the physical environment [8,13], and in specific, parks and walking areas, adequate parking facilities for persons with disabilities, and public transportation have been associated with functioning and disability in older adults [14] The ability of older people to function and remain active in their setting of choice and to continue to enjoy their desired level of support and interaction with other people are the main indicators that an environment is positive [15]. The physical characteristics of the built environment influence significantly mobility, independence and quality of life of ageing population living in a local community [16].…”