Outdoor spaces and buildings, transportation, and environmental justice: A qualitative interpretive meta-synthesis of two age-friendly domains

https://doi.org/10.1016/j.jth.2020.100977Get rights and content

Highlights

  • Themes of accessibility and appropriate infrastructure emerged.

  • Age-friendliness can be conceptualized as environmental justice.

  • An environmental justice framework is useful to evaluate age-friendliness.

Abstract

Background

Age-friendly environments promote healthy and active aging by building and maintaining capacity across the life course and allowing people who have a loss of capacity to continue engaging in activities that they value. Existing research demonstrates that municipalities are conducting age-friendly assessments worldwide.

Purpose

The current study aims to create a rich description of older adults' experiences with outdoor spaces, buildings, and transportation as part of an age-friendly assessment.

Method

A qualitative interpretive meta-synthesis (QIMS) was conducted to increase the number of studies eligible for analysis by allowing the inclusion of several existing qualitative studies from several countries. The QIMS included a systematic sampling and data analysis (i.e., theme extraction, theme synthesis, and methodological reduction) procedures and establishment of evidence credibility.

Results

The themes that emerged regarding older adults' experiences with outdoor space and buildings included 1) accessibility and 2) appropriate infrastructure. Regarding transportation, the theme of accessibility included subthemes of 1) availability and 2) affordability. Further reduction indicated that age-friendliness could be conceptualized as an environmental justice (EJ) issue.

Conclusions

The three areas of EJ (i.e., distributional justice, procedural justice, and recognition) provide a helpful framework to guide the systematic documentation and evaluation of age-friendly community efforts. Moreover, interprofessional collaborations are needed to address transportation equity and inclusion better.

Introduction

Worldwide, people are living longer and the number of people living in urban areas is increasing. Demographers estimate that between 2015 and 2050, the number of adults aged 60 and older will more than double from 900 million to 2 billion (World Health Organization, 2018a). The World Health Organization (WHO) (2007b) predicts that three out of five people will live in cities by 2030. The WHO designated 2020–2030 as the Decade of Healthy Ageing, which presents an opportunity to create synergy among interdisciplinary professionals to improve the lives of older adults, their families, and the community (WHO, 2020).

In preparation for the substantial increase in the number of older adults worldwide, WHO (2007b) launched the Age-Friendly Cities and Communities Initiative. The goal of the age-friendly initiative is to improve the accessibility and inclusivity of urban environments, dispel ageism, increase autonomy, and support healthy aging (WHO, 2019). Age-friendly environments promote healthy and active aging by building and maintaining capacity across the life course and allowing people who have a loss of capacity to continue engaging in the activities that they value (WHO, 2018b). Active aging is the “process of optimizing opportunities for health, participation, and security to enhance the quality of life as people age” (WHO, 2002, p. 12). The designers of age-friendly environments seek to eliminate physical and social barriers and proactively anticipate and respond to the needs and preferences of older adults. Additionally, they aim to reduce inequalities, protect vulnerable individuals, and promote the inclusion and contributions of older adults (WHO, 2018b), efforts that align with environmental justice issues. Presently, the WHO Global Network of Age-Friendly Cities includes 41 countries and 847 communities and cities covering over 230 million people (WHO, 2019).

The WHO's Global Network of Age-Friendly Cities and Communities have identified eight domains of livability that increase the quality of life of older adults (WHO, 2019). These domains include 1) outdoor spaces and buildings, 2) transportation, 3) housing, 4) social participation, 5) respect and social inclusion, 6) civic participation and employment, 7) communication and information, and 8) community and health services. The purpose of this qualitative interpretative meta-synthesis (QIMS) is to examine the lived experiences of older adults involved in age-friendly community assessments. This QIMS focused explicitly on the domains of 1) outdoor spaces and buildings and 2) transportation to highlight environmental elements that allow people who have a loss of mobility to continue engaging in activities and services that benefit their health and well-being.

WHO's Checklist of Essential Features of Age-friendly Cities (2007a) delineates the characteristics of each domain. The characteristics of outdoor spaces and buildings include public areas that are clean and pleasant. Green spaces are safe, well-maintained, and have substantial outdoor seating. Pavements for pedestrians are unobstructed, well-maintained, and wheelchair accessible. There are enough crosswalks, and they are safe and accessible. Bicycle paths are separate from pavements, and other pedestrian walkways and streets are well lit. Services are accessible and close together. Buildings are accessible (e.g., elevators, ramps, railings, non-slip floors) for people with mobility difficulties and provide enough seating and toilets.

Regarding the transportation domain, public transportation should be available, affordable, and reliable. All areas of the city should be accessible with good connections, and well-marked vehicles and routes. Public vehicles should be clean, accessible, well-maintained, and have enforced priority seating. Specialized transportation should be available to people with disabilities. Transportation drivers should stop near the curb at designated stops and wait for passengers to board before resuming driving. Transportation stops and stations should be conveniently located, accessible, and have enough seating and shelter. Taxis should be accessible and affordable. Roads should be well-maintained, free of obstructions, with good lighting and adequate drainage systems. The traffic flow should be well-regulated, and traffic signs should be easy to see.

Existing research demonstrates that several municipalities are conducting age-friendly assessments worldwide. These assessments illustrate the importance of age-friendliness, especially the domains of transportation and outdoor spaces and buildings and the impact these domains have on active aging (Lai et al., 2016) and health (Alidoust et al., 2019). Age-friendly community programs often include qualitative components as part of their ‘toolkit’ for monitoring and evaluation such as conducting focus groups and/or individual interviews with older adults (Neal and Iris, 2014). In order to better understand the perspectives of older adults related to the domains of transportation and outdoor spaces/buildings, a qualitative interpretive meta-synthesis is needed. The benefit of the integrating the voices of older adults themselves in solving transportation challenges has been previously documented (Dabelko-Schoeny et al., 2020). The aims of a QIMS are to join various qualitative accounts into a “web of knowledge” about a topic (e.g. age-friendliness) that results in a “new, deeper, and broader understanding” (Aguirre and Bolton, 2013, p. 5). Thus, the objective of this QIMS is to explore the lived-experiences of older adults related to interacting with outdoor spaces and transportation.

Section snippets

Method

Scholars have conducted QIMS to better understand a variety of topics among various populations, including resilience of older adults (Bolton et al., 2016) and older adults' experiences with homelessness (Murphy and Eghaneyan, 2018). To date, a QIMS has not been conducted to examine older adults’ experiences with 1) outdoor spaces and buildings and 2) transportation as part of an age-friendly assessment. We utilized the QIMS methodology since research on older adults' perspectives on

Results

The themes that emerged from the analysis regarding older adults' experiences with outdoor space and buildings included 1) accessibility and 2) appropriate infrastructure. Regarding transportation, the theme of accessibility and the subthemes of 1) availability and 2) affordability emerged. These themes and relevant subthemes are discussed below, with examples of older adults’ narratives. Pseudonyms were given to the participants to protect their identity when not given in the reviewed study.

Discussion

The purpose of this QIMS was to examine the lived experiences of older adults involved in age-friendly community assessments, focusing on the domains of transportation and public spaces and buildings. These domains were selected to highlight environmental elements that allow people who have a loss of capacity to continue engaging in activities and services, an important predictor of health and wellbeing. Moreover, to foster healthy aging, there is a need to focus on and invest in age-friendly

Conclusion

Hearing the lived experience of older adults participating in the assessment of age-friendly communities using the QIMS methodology allows for a deeper understanding of the relationships between key themes related to transportation and accessing outdoor spaces and buildings and the opportunities for research and practice. Taken on their own, each of the included studies provides a unique view of age-friendly communities. However, the synthesis of the qualitative studies and the subsequent

Funding

Financial support for this study was provided by the Ohio Department of Transportation.

References (50)

  • N.L. Fields et al.

    Interprofessional collaboration to promote transportation equity for environmental justice populations: A mixed methods study of civil engineers, transportation planners, and social workers’ perspectives

    Trans. Res. Interdiscipl. Perspect.

    (2020)
  • D. Rowangould et al.

    Identifying environmental justice communities for transportation analysis

    Transport. Res. Part A

    (2016)
  • G. Adorno et al.

    Ageing in a low-density urban city: Transportation mobility as a social equity issue

    Ageing Soc.

    (2018)
  • S. Alidoust et al.

    Planning for healthy aging: how the use of third places contributed to the social health of older adults

    Ageing Soc.

    (2019)
  • R.T.P. Aguirre et al.

    Why do they do it? A quali- tative interpretive meta-synthesis of crisis volunteers’ motivations

    Soc. Work. Res.

    (2013)
  • R.T.P. Aguirre et al.

    Qualitative interpretive meta-synthesis in social work research: uncharted territory

    J. Soc. Work

    (2014)
  • American Association for Retired Persons. (n.d.). AARP livable communities. Retrieved from...
  • Association of Metropolitan Planning Organizations

    More than mobility: examining the impacts of EJ populations

  • S. Bell et al.

    You don't want to ask for the help" the imperative of independence: is it related to social exclusion?

    J. Appl. Gerontol.

    (2015)
  • R. Bernet

    The phenomenological reduction: from natural life to philosophical thought

    Metodo: International Studies in Phenomenology and Philosophy

    (2016)
  • C. Bigonnesse et al.

    Meaning of home in later life as a concept to understand older adults' housing needs: results from the 7 age-friendly cities pilot project in Quebec

    J. Hous. Elder.

    (2014)
  • K.W. Bolton et al.

    Resil- ience protective factors in an older adult population: A qualita- tive interpretive meta-synthesis

    Soc. Work. Res.

    (2016)
  • B.I. Bryant

    Environmental Justice: Issues, Policies, and Solutions

    (1995)
  • T. Buffel et al.

    A manifesto for the age-friendly movement: Developing a new urban agenda

    J. Aging Soc. Pol.

    (2018)
  • C.H. Chui et al.

    Older adults' perceptions of age-friendliness in Hong Kong

    Gerontol.

    (2019)
  • L.W. Cole et al.

    From the Ground up: Environmental Racism and the Rise of the Environmental Justice Movement

    (2001)
  • J.M. Cramm et al.

    The creation of age-friendly environments is especially important to frail older people

    Ageing Soc.

    (2018)
  • J.W. Creswell

    Qualitative Inquiry and Research Design: Choosing Among Five Approaches

    (2007)
  • H. Dabelko-Schoeny et al.

    Using community-based participatory research strategies in age-friendly communities to solve mobility challenges

    J. Gerontol. Soc. Work

    (2020)
  • A.E. Dickerson et al.

    Transportation and aging: an updated research agenda to advance safe mobility among older adults transitioning from driving to non-driving

    Gerontol.

    (2019)
  • P. Doran et al.

    Translating research into action: involving older people in co- producing knowledge about age-friendly neighbourhood interventions

    Work. Older People

    (2018)
  • N.L. Fields et al.

    Age-friendly cities: The role of churches

    J. Relig. Spiritual. Aging

    (2016)
  • N. Fields et al.

    “You Are Really at Their Mercy”: Examining the relationship between transportation disadvantage and social exclusion among older adults through the use of innovative technology

    Transport. Res. Rec.

    (2019)
  • D.H. John et al.

    engAGE in community: using mixed methods to mobilize older people to elucidate the age-friendly attributes of urban and rural places

    J. Appl. Gerontol.

    (2016)
  • M. Lai et al.

    Modeling age-friendly environment, active aging, and social connectedness in an emerging Asian economy

    Journal of Aging Research

    (2016)
  • 1

    Present address: The University of Tennessee-Knoxville, 1618 W. Cumberland Ave., Knoxville, TN 37996 USA.

    View full text