World Health Organisation

Global Age-friendly Cities: A Guide

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

PAGE iI

Global age-friendly cities : a guide.

1.Aged - statistics. 2.Aging. 3.Urban health. 4.City planning. 5.Residence characteristics. 6.Quality of life.

7.Consumer participation. 8.Strategic planning. I.World Health Organization.

ISBN 978 92 4 154730 7 (NLM classifi cation: WT 31)

© World Health Organization 2007

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AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Table of Contents

PAGE iV

Acknowledgements

This project was conceived in June 2005 at the opening session of the XVIII IAGG World Congress of

Gerontology and Geriatrics in Rio de Janeiro, Brazil. It immediately attracted enthusiastic interest, which

has translated into generous contributions from many partners. We gratefully acknowledge the funding and

in-kind support provided by the Public Health Agency of Canada, which was crucial for implementing the

research, the participation of several cities and the publication of this Guide.

We also extend our appreciation to the Ministry of Health of British Columbia for supporting the initial

meeting of collaborating cities in May, 2006 in Vancouver, Canada; to 2010 Legacies Now for funding the

publication of a promotional pamphlet; to Help the Aged for enabling the participation of two cities and for

supporting the second meeting of collaborating cities in London, United Kingdom, in March 2007; and to the

City of Ottawa, Canada, for pilot testing the research protocol. The implementation of the research project

and attendance at project meetings was made possible by government and local funding in most of the collaborating

cities.

The project benefi ted at all phases from the guidance of an advisory group, the members of which we warmly

thank: Margaret Gillis, Public Health Agency of Canada; James Goodwin, Help the Aged, United Kingdom;

Tessa Graham, Ministry of Health of British Columbia, Canada; Gloria Gutman, Simon Fraser University,

Canada; Jim Hamilton, Healthy Aging Secretariat of Manitoba, Canada; Nabil Kronful, Lebanese Healthcare

Management Association, Lebanon; Laura Machado, Inter-Age Consulting in Gerontology, Brazil; and Elena

Subirats-Simon, Acción para la Salud, Mexico.

The Global Age-Friendly Cities project was developed by Alexandre Kalache and Louise Plouffe, WHO headquarters,

Geneva, Switzerland, and the report was produced under their overall direction. Substantial intellectual

contributions in the data analysis and preparation of the report were made by Louise Plouffe; Karen

Purdy, Offi ce for Seniors Interests and Volunteering, Government of Western Australia; Julie Netherland, Ana

Krieger and Ruth Finkelstein, New York Academy of Medicine; Donelda Eve, Winnie Yu and Jennifer MacKay,

Ministry of Health of British Columbia; and Charles Petitot, WHO headquarters.

The research protocol was implemented in the following 33 cities thanks to the efforts of governments,

nongovernmental organizations and academic groups:

Amman, Jordan

Cancún, Mexico

Dundalk, Ireland

Geneva, Switzerland

Halifax, Canada

Himeji, Japan

Islamabad, Pakistan

Istanbul, Turkey

Kingston and Montego

Bay (combined), Jamaica

La Plata, Argentina

London, United

Kingdom

Mayaguez, Puerto Rico

Melbourne, Australia

Melville, Australia

Mexico City, Mexico

Moscow, Russian

Federation

Nairobi, Kenya

New Delhi, India

Ponce, Puerto Rico

Portage la Prairie,

Canada

Portland, Oregon,

United States of America

Rio de Janeiro, Brazil

Ruhr metropolitan

region, Germany

Saanich, Canada

San José, Costa Rica

Shanghai, China

Sherbrooke, Canada

Tokyo, Japan

Tripoli, Lebanon

Tuymazy, Russian

Federation

Udaipur, India

Udine, Italy

Finally, special gratitude is expressed to the older people in all research locations, as well as to the caregivers

and service providers who were also consulted in many sites. In focus groups, these people articulated

the model of an age-friendly city based on their experience that is at the heart of this Guide. These older

people and those who interact with them in signifi cant ways will continue to play a critical role as community

advocates and overseers of action to make their cities more age-friendly.

PAGE 1

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Introduction: about this Guide

Population ageing and urbanization are

two global trends that together comprise

major forces shaping the 21st century. At

the same time as cities are growing, their

share of residents aged 60 years and more is

increasing. Older people are a resource for

their families, communities and economies

in supportive and enabling living environments.

WHO regards active ageing as a lifelong

process shaped by several factors that,

alone and acting together, favour health,

participation and security in older adult

life. Informed by WHO’s approach to active

ageing, the purpose of this Guide is to

engage cities to become more age-friendly

so as to tap the potential that older people

represent for humanity.

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.

In practical terms, an age-friendly city

adapts its structures and services to be

accessible to and inclusive of older people

with varying needs and capacities.

To understand the characteristics of an

age-friendly city, it is essential to go to

the source – older city dwellers. By working

with groups in 33 cities in all WHO

regions, WHO has asked older people in

focus groups to describe the advantages

and barriers they experience in eight areas

of city living. In most cities, the reports

from older people were complemented by

evidence from focus groups of caregivers

and service providers in the public, voluntary

and private sectors. Th e results from

the focus groups led to the development of

a set of age-friendly city checklists.

• Part 1 describes the converging trends

of rapid growth of the population over

60 years of age and of urbanization, and

outlines the challenge facing cities.

• Part 2 presents the “active ageing” concept

as a model to guide the development

of age-friendly cities.

• Part 3 summarizes the research process

that led to identifying the core features of

an age-friendly city.

• Part 4 describes how the Guide should be

used by individuals and groups to stimulate

action in their own cities.

• Parts 5–12 highlight the issues and concerns

voiced by older people and those

who serve older people in each of eight

areas of urban living: outdoor spaces and

buildings; transportation; housing; social

participation; respect and social inclusion;

civic participation and employment;

communication and information; and

community support and health services.

In each part, the description of the fi ndings

concludes with a checklist of core

age-friendly city features obtained by

analysing the reports from all cities.

PAGE 2

• Part 13 integrates the fi ndings within

the WHO active ageing perspective and

highlights strong connections between the

age-friendly city topics. Th ese reveal the

principal traits of the “ideal” age-friendly

city and show how changing one aspect

of the city can have positive eff ects on the

lives of older people in other areas. Seized

by the promise of more age-friendly communities,

WHO collaborators are now

undertaking initiatives to translate the

research into local action, to expand the

scope beyond cities, and to spread it to

more communities. An age-friendly community

movement is growing for which

this Guide is the starting point.

PAGE 3

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Part 1. Global ageing and urbanization:

meeting the challenge of

humanity’s success

Th e world is rapidly ageing: the number of

people aged 60 and over as a proportion of

the global population will double from 11%

in 2006 to 22% by 2050. By then, there will

be more older people than children (aged

0–14 years) in the population for the fi rst

time in human history (1). Developing countries

are ageing at a much faster rate than

developed countries: within fi ve decades,

just over 80% of the world’s older people will

be living in developing countries compared

with 60% in 2005 (2).

At the same time, our world is a growing

city: as of 2007, over half of the global population

now lives in cities (3). Mega-cities,

that is, cities with 10 million inhabitants or

more, increased tenfold from 2 to 20 during

the 20th century, accounting for 9% of the

world’s urban population by 2005 (4). Th e

number and proportion of urban dwellers

will continue to rise over the coming decades,

and particularly in cities with fewer

than fi ve million inhabitants (5). Again, this

growth is happening much more rapidly in

developing regions. By 2030, about three

out of every fi ve people in the world will live

in cities and the number of urban dwellers

in the less developed regions will be almost

four times as large as that in the more developed

regions (Fig. 2) (6).

North Oceania

America

Latin

America

and the

Caribbean

Africa Asia Europe

PAGE 4

More older people are also living in cities.

Th e proportion of the older adult population

residing in cities in developed countries

matches that of younger age groups at

about 80%, and will rise at the same pace.

In developing countries, however, the share

of older people in urban communities will

multiply 16 times from about 56 million in

1998 to over 908 million in 2050. By that

time, older people will comprise one fourth

of the total urban population in less developed

countries (7).

Population ageing and urbanization are the

culmination of successful human development

during last century. Th ey also are major

challenges for this century. Living longer

is the fruit of critical gains in public health

and in standards of living. As stated in the

WHO Brasilia Declaration on Ageing (8) in

1996, “healthy older people are a resource

for their families, their communities and the

economy”. Urban growth is associated with a

country’s technological and economic development.

Vibrant cities benefi t a country’s entire

population – urban and rural. Because

cities are the centre of cultural, social and

political activity, they are a hothouse for new

ideas, products and services that infl uence

other communities and therefore the world.

Yet to be sustainable, cities must provide

the structures and services to support their

residents’ wellbeing and productivity. Older

people in particular require supportive and

enabling living environments to compensate

for physical and social changes associated

with ageing. Th is necessity was recognized

as one of the three priority directions of

the Madrid International Plan of Action on

Ageing endorsed by the United Nations in

2002 (9). Making cities more age-friendly is

a necessary and logical response to promote

the wellbeing and contributions of older urban

residents and keep cities thriving. And

North Oceania

America

Latin

America

and the

Caribbean

World Africa Asia Europe

PAGE 5

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Economic

determinants

Health and

social services

Behavioural

determinants

Personal

determinants

Physical

environment

Social

determinants

Part 2. Active ageing:

a framework for age-friendly cities

Th e idea of an age-friendly city presented in

this Guide builds on WHO’s active ageing

framework (10).

Active ageing is the process of optimizing

opportunities for health, participation and

security in order to enhance quality of life

as people age.

In an age-friendly city, policies, services,

settings and structures support and enable

people to age actively by:

• recognizing the wide range of capacities

and resources among older people;

• anticipating and responding fl exibly to

ageing-related needs and preferences;

• respecting their decisions and lifestyle

choices;

• protecting those who are most vulnerable;

and

• promoting their inclusion in and contribution

to all areas of community life.

Active ageing depends on a variety of infl uences

or determinants that surround individuals,

families and nations. Th ey include

material conditions as well as social factors

that aff ect individual types of behaviour

and feelings (11). All of these factors, and

the interaction between them, play an important

role in aff ecting how well individuals

age. Many aspects of urban settings and

services refl ect these determinants and are

included in the characteristic features of an

age-friendly city (Fig. 3).

PAGE 6

Th ese determinants have to be understood

from a life course perspective that recognizes

that older people are not a homogeneous

group and that individual diversity

increases with age. Th is is expressed in Fig.

4, which illustrates that functional capacity

(such as muscular strength and cardiovascular

output) increases in childhood, peaks

in early adulthood and eventually declines.

Th e rate of decline is largely determined by

factors related to lifestyle, as well as external

social, environmental and economic factors.

From an individual and societal perspective,

it is important to remember that the speed

of decline can be infl uenced and may be

reversible at any age through individual and

public policy measures, such as promoting

an age-friendly living environment.

Because active ageing is a lifelong process,

an age-friendly city is not just “elderlyfriendly”.

Barrier-free buildings and streets

enhance the mobility and independence of

people with disabilities, young as well as

old. Secure neighbourhoods allow children,

younger women and older people to venture

outside in confi dence to participate in physically

active leisure and in social activities.

Families experience less stress when their

older members have the community support

and health services they need. Th e whole

community benefi ts from the participation

of older people in volunteer or paid work.

Finally, the local economy profi ts from the

patronage of older adult consumers. Th e

operative word in age-friendly social and

physical urban settings is enablement.

Range of function

in individuals

Age

Growth and

development

Maintaining highest

possible level of function

Maintaining independence

andpreventing disability

Rehabilitation and ensuring

the quality of life

Disability threshold*

Functional Capacity

PAGE 7

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Part 3. How the Guide was developed

A total of 35 cities from all continents participated

in the WHO project leading to the

Guide, and 33 of these cities participated in

focus group research thanks to the collaboration

of government offi cials and nongovernmental

and academic groups (1). Th ese

cities represent a wide range of developed

and developing countries (Fig. 5). Th ey

refl ect the diversity of contemporary urban

settings, including six current mega-cities

with over 10 million inhabitants (Mexico

City, Moscow, New Delhi, Rio de Janeiro,

Shanghai and Tokyo), “almost mega-cities”

such as Istanbul, London and New York, as

well as national capitals, regional centres

and small cities.

Th e bottom-up participatory approach

(13) involves older people in analysing and

expressing their situation to inform government

policies. It is recommended by the

United Nations for empowering older people

to contribute to society and to participate

in decision-making processes. Because

older people are the ultimate experts on

their own lives, WHO and its partners in

1. Edinburgh contributed information on the city’s agefriendliness,

based on a large survey and individual

interviews collected a few months prior to the WHO

project. The information from Edinburgh, using a different

but complementary methodology, provided additional

confi rmation of the fi ndings from focus groups.

New York City was closely involved in the data analysis

and in the development of the next phases of the Global

Age-Friendly Cities project.

each city have involved older people as full

participants in the project. Project leaders

sought the fi rst-hand experience of older

people. What are the age-friendly features

of the city they live in? What problems do

they encounter? What is missing from the

city that would enhance their health, participation

and security?

Focus groups were set up with older people

aged 60 years and older from lower- and

middle-income areas. A total of 158 such

groups, involving 1485 participants, were

organized between September 2006 and

April 2007. Older people were the main

source of information in all the 33 cities

that conducted focus groups. To obtain the

views of people who would be unable to

attend focus groups owing to physical or

mental impairment, most cities also held

a focus group with caregivers who talked

about the experience of the older people for

whom they were caring.

To complement the information from

older people and caregivers, most cities

also conducted focus groups with service

providers from the public, voluntary and

commercial sectors. In all, 250 caregivers

and 515 service providers were included in

the consultations. Th ese people made observations

based on their interactions with

older people. Th e caregivers and service

providers sometimes provided information

that older people did not report, but the

information from both groups was always

consistent with the views expressed by

PAGE 8

The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the

World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers

or boundaries. Dashed lines represent approximate border lines for which there may not yet be full agreement.

Argentina, La Plata

Brazil, Rio de Janeiro

Canada, Halifax

Canada, Portage la Prairie

Canada, Saanich

Canada, Sherbrooke

Costa Rica, San Jose

Jamaica, Kingston

Jamaica, Montego Bay

Mexico, Cancun

Mexico, Mexico City

Puerto Rico, Mayaguez

Puerto Rico, Ponce

USA, New York

USA, Portland

Kenya, Nairobi

Jordan, Amman

Lebanon, Tripoli

Pakistan, Islamabad

Germany, Ruhr

Ireland, Dundalk

Italy, Udine

Russia, Moscow

Russia, Tuymazy

Switzerland, Geneva

Turkey, Istanbul

UK, Edinburgh

UK, London

India, New Delhi

India, Udaipur

Australia, Melbourne

Australia, Melville

China, Shanghai

Japan, Himeji

Japan, Tokyo

older people.

A total of eight topics were explored in

the focus groups to give a comprehensive

picture of the city’s age-friendliness.

Th e topics cover the features of the city’s

structures, environment, services and policies

that refl ect the determinants of active

ageing. Th e topics had been identifi ed in

previous research with older people on the

characteristics of elderly-friendly communities

(14,15). Th e same basic questions

PAGE 9

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

about each area were asked in the focus

groups in all cities.

Th e fi rst three topics were outdoor spaces

and buildings, transportation, and housing.

As key features of a city’s physical environment,

they have a strong infl uence on

personal mobility, safety from injury, security

from crime, health behaviour and social

participation. Another three topics refl ect

diff erent aspects of the social environment

and of culture that aff ect participation and

mental wellbeing. Respect and social inclusion

deals with the attitudes, behaviour and

messages of other people and of the community

as a whole towards older people. Social

participation refers to the engagement of

older people in recreation, socialization, and

cultural, educational and spiritual activities.

Civic participation and employment addresses

opportunities for citizenship, unpaid

work and paid work; it is related to both the

social environment and to the economic

determinants of active ageing. Th e last two

topic areas, communication and information

and community support and health

services, involve both social environments

and health and social service determinants.

Th e cross-cutting active ageing determinants

of culture and gender were included

only indirectly in this project, because

their infl uence on active ageing extends far

beyond urban living. Owing to their overriding

infl uence, these determinants merit

specially focused initiatives.

As with the determinants of active ageing,

these eight aspects of city life overlap

and interact. Respect and social inclusion

are refl ected in the accessibility of the

buildings and spaces and in the range of

opportunities that the city off ers to older

people for social participation, entertainment

or employment. Social participation,

in turn, infl uences social inclusion, as well

Housing

Social participation

Respect and

social inclusion

Civic participation

and employment

Communication

and information

Community support

and health services

Outdoor spaces

and buildings

Transportation

PAGE 10

as access to information. Housing aff ects

needs for community support services,

while social, civic and economic participation

partly depend on the accessibility and

safety of outdoor spaces and public buildings.

Transportation and communication

and information particularly interact with

the other areas: without transportation or

adequate means of obtaining information to

allow people to meet and connect, other urban

facilities and services that could support

active ageing are simply inaccessible. Fig. 6

depicts the age-friendly city topic areas.

For each topic, the reports of age-friendly

aspects of the city, the barriers and gaps,

and the suggestions for improvement

voiced by focus group participants in all

cities were transcribed and grouped into

themes. Th e themes that were mentioned

in each city were recorded to form a picture

of what was most important overall and in

diff erent regions and cities. Based on the

themes, a checklist of the core features of

an age-friendly city was developed in each

area of city living. Th e checklist is a faithful

summary of the views expressed by the

focus group participants worldwide.

PAGE 11

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Part 4. How to use the Guide

Th e purpose of this Guide is to help cities

see themselves from the perspective of

older people, in order to identify where and

how they can become more age-friendly.

Th e following parts of the Guide describe,

for every area of city life, the advantages

and barriers that older people experience

in cities at diff erent stages of development.

Th e checklist of core age-friendly features

concluding each part applies to less developed

as well as more developed cities. It is

intended to provide a universal standard for

an age-friendly city.

Th e age-friendly features checklist is not a

system for ranking one city’s age-friendliness

against another’s; rather, it is a tool for

a city’s self-assessment and a map to chart

progress. No city is too far behind to make

some signifi cant improvements based on

the checklist. Going beyond the checklist

is possible, and indeed some cities already

have features that exceed the core. Th ese

good practices provide ideas that other cities

can adapt and adopt. Nevertheless, no city

provides a “gold standard” in every area.

Th e checklists of age-friendly urban features

are neither technical guidelines nor

design specifi cations. Other technical documentation

is available to help implement

changes that may be required in individual

cities (16,17).

Th e Guide is intended to be used by individuals

and groups interested in making

their city more age-friendly, including governments,

voluntary organizations, the private

sector and citizens’ groups. Th e same

principle followed in creating the Guide applies

to using it; that is: involve older people

as full partners at all stages. In assessing

the city’s strengths and gaps, older people

will describe how the checklist of features

matches their own experiences. Th ey will

provide suggestions for change and they

may participate in implementing improvement

projects. Th e situation of older people

articulated through this bottom-up approach

provides the essential information

to be distilled and analysed by gerontology

experts and decision-makers in developing

or adapting interventions and policies. In

the follow-up stages of “age-friendly” local

action, it is imperative that older people

continue to be involved in monitoring the

city’s progress and acting as age-friendly

city advocates and advisers.

PAGE 12

Part 5. Outdoor spaces and buildings

Th e outside environment and public buildings

have a major impact on the mobility,

independence and quality of life of older

people and aff ect their ability to “age in

place”. In the WHO project consultation,

older people and others who interact signifi

cantly with them describe a broad range

of characteristics of the urban landscape

and built environment that contribute to

age-friendliness. Th e recurring themes in

cities around the world are quality of life,

access and safety. Improvements that have

been made or that are under way in cities at

all stages of development are welcomed by

those consulted, who also point out other

changes that ought to be made.

Th e beauty of the city’s natural surroundings

is a feature that people in many cities

mention spontaneously as an age-friendly

feature. For example, in Rio de Janeiro and

Cancún, living close to the ocean is seen

as a defi nite advantage, as is living close to

the river in Melville and London. In Himeji,

older people value the quiet and peacefulness

of their environment. At the same

time, older people do express complaints

with respect to their city’s cleanliness and

to disturbing noise levels and odours.

Older person, Istanbul

In Tripoli, the smell of smoke from narguileh

(oriental water pipes) is said to be

“suff ocating”, especially in the evenings and

during Ramadan. In Jamaica, concern is

expressed at the loudness of music, compounded

by the explicit language used in

the songs. In a number of cities, the perceived

dirtiness of the city detracts from

older residents’ quality of life. To address

these problems, people in Mexico City

suggest that a “clean street” campaign be

organized, while in Jamaica, regulations addressing

noise levels are recommended.

Th e size of the city is thought to be a problem

in some cities. Th e increasing numbers

of people in Tokyo are thought to be linked

to a reduction in community cohesiveness.

Nairobi is considered to be overcrowded

and diffi cult for older people to get around.

PAGE 13

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Having green spaces is one the most commonly

mentioned age-friendly features.

However, in many cities there are barriers

that prevent older people from using green

spaces. In New Delhi, for example, some

green spaces are said to be poorly maintained

and have become “dumps”, and in

Himeji, some parks are considered to be

unsafe. Concern is expressed in Melville

about the inadequate toilet facilities and

lack of seating. In Moscow it is reported

that there is no protection from the weather,

while in Udaipur diffi culties in getting

to the parks are highlighted. Another issue

of concern is hazards resulting from shared

use of the park.

Service provider, Melbourne

Diff erent suggestions are off ered to resolve

these problems. Caregivers in Halifax see

a need for small, quieter, contained green

spaces in the fringe areas of the city rather

than the large busy parks used by children

and skateboarders. Older people in Amman

recommend special gardens for their age

group, while older people in New Delhi

suggest demarcated areas in parks for older

people. Better park maintenance is called

for in several locations.

Th e availability of seating areas is generally

viewed as a necessary urban feature for

older people: it is diffi cult for many older

people to walk around their local area without

somewhere to rest.

Older person, Melville

Older people and caregivers in Shanghai

appreciate the relaxing rest areas in their

city. In Melbourne, the redevelopment of

outdoor seating areas is viewed positively.

Yet there is some concern about encroachment

into public seating areas by people or

groups who are intimidating or who display

antisocial behaviour. In Tuymazy, for

example, it was requested that the public

seating be removed for this very reason.

Th e condition of pavements has an obvious

impact on the ability to walk in the local

area. Pavements that are narrow, uneven,

cracked, have high curbs, are congested or

have obstructions present potential hazards

and aff ect the ability of older people to walk

around.

Older person, Dundalk

Inadequate pavements are reported as an

almost universal problem. In many cities,

such as Mexico City, Rio de Janeiro and

those in Jamaica, pedestrians are forced to

PAGE 14

share the pavements with street vendors.

In other cities, such as La Plata, Moscow,

Ponce and the Ruhr metropolitan region,

cars parked on the pavement force pedestrians

to walk on the road. Th e weather

may compound the diffi culties experienced

by older people using pavements. In

Sherbrooke, for example, concern is expressed

about snow not being cleared from

the pavements and in Portage la Prairie, the

risk of falls is considered greater after it has

snowed.

Approval is expressed for improvements

that some cities are making to the design

and maintenance of pavements. Th e following

features to make pavements age-friendly

are often suggested:

• a smooth, level, non-slip surface;

• suffi cient width to accommodate wheelchairs;

• dropped curbs that taper off to be level

with the road;

• clearance from obstructions such as

street vendors, parked cars and trees; and

• priority of access for pedestrians.

Older person, La Plata

Th e ability to cross the road safely is an

often mentioned concern, and it is reported

that several cities have taken steps to improve

the conditions for people crossing the

road: traffi c lights at pedestrian crossings in

Cancún; traffi c islands in La Plata; pedestrian

crossings in Mayaguez, and non-slip

strips on pedestrian crossings in Portland.

Amman has built bridges and tunnels to

assist pedestrians to cross roads.

In quite a few cities, it is reported that

the pedestrian crossing lights change too

quickly. In Melville, it is suggested that the

crossing lights have a visual “countdown” so

that pedestrians know how much time they

have to cross the road. Th e auditory signals

at pedestrian crossings are much appreciated

in Istanbul, and in Portland and Udine,

auditory as well as visual cues at crossings

are recommended.

Older person, Halifax

Another common concern is that drivers

fail to follow traffi c signals and do not give

way to pedestrians.

Older person, Jamaica

PAGE 15

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

In most of the cities, the volume and speed

of road traffi c is said to present barriers for

older people, both as pedestrians and as

drivers. In Udaipur, it is reported that the

traffi c is chaotic and older people fear going

out because of heavy traffi c; some will not

go out unless they are accompanied. (Th e

diffi culties encountered by older drivers are

discussed in Part 7.)

In both developed and developing countries,

people think that their city was not

designed for older people.

Older person, Nairobi

In many cities, reference is made to barriers

to physical access, which can discourage

older people from leaving their homes.

In Rio de Janeiro, it is pointed out that the

concrete ladders to access the favela (shanty

town) are diffi cult for older people to use.

Th e lack of ramps in some areas is an issue

in Sherbrooke. Th e common recommendation

for addressing these concerns is education,

particularly for urban planners and

architects, about the needs of older people.

Feeling secure in one’s living environment

strongly aff ects people’s willingness to

move about in the local community, which

in turn aff ects their independence, physical

health, social integration and emotional

well-being. Many cities are considered to

be generally safe from harm by others, but

others clearly are not. Regardless of the actual

level of danger, concerns about security

are expressed nearly everywhere, including

matters such as street lighting, violence,

crime, drugs and homelessness in public

places. Going out at night is especially fearful

for many older people.

Older person, Tuymazy

It is acknowledged that some cities have

taken measures to improve security; for

example, it is pointed out that Geneva and

Sherbrooke have installed surveillance

cameras.

A suggestion made in La Plata to improve

security is to involve the community, such

as promoting self-organized groups among

older people for greater outdoor safety as

well as providing more police. In Dundalk,

it is suggested that the government provide

a grant to enable older people to improve

their personal security.

Earthquakes occur frequently in Turkey,

and older people in Istanbul are concerned

that the city is not designed to minimize

the risk of injury resulting from earthquakes.

PAGE 16

Older person, Istanbul

Walkways and cycle paths are seen as

part of a health promoting, age-friendly

environment, yet there are hazards noted

as well. In Geneva, cyclists are thought

by some to be a danger to older people.

In Udine, it is suggested there should be

two pathways – one for cyclists and one

for pedestrians. Older people in Cancún,

Portland and Saanich value the walking

trails provided in their cities. Th e need to

ensure walkways have a smooth surface is

highlighted by caregivers in Halifax, and

the need to ensure they are easy to access

with suffi cient wheelchair access points is

mentioned by older people and caregivers

in Portage la Prairie. Older people in Udine

advise developing a system of walkways

to move through the area, and in Halifax,

walkways in car parks are called for to

ensure the safety of pedestrians. Adding

public toilets near walkways is another idea

put forward in Saanich.

In many cities, including Himeji, Mayaguez,

Melbourne and New Delhi, reference is

made to new buildings being accessible and

improvements being made to make buildings

more accessible. Generally, the features

that are considered necessary for buildings

to be age-friendly are:

• elevators

• escalators

• ramps

• wide doorways and passages

• suitable stairs (not too high or steep) with

railings

• non-slip fl ooring

• rest areas with comfortable seating

• adequate signage

• public toilets with handicap access.

In two cities, however, barriers to older

people using elevators are mentioned. In

Nairobi, older people have a fear of using elevators

and need to be accompanied; while

in Tripoli, older people are reluctant to use

elevators as electricity failures are common

and they fear being stranded.

While there is widespread recognition of

the importance of having accessible buildings,

it is also widely acknowledged that

many buildings, particularly old buildings,

are not accessible. In some cases, it is not

possible to make old buildings more accessible.

Most of the cities see a need to

improve the accessibility of their buildings,

particularly to facilitate wheelchair access.

Some positive and negative attributes of

PAGE 17

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

large shopping centres are also mentioned.

In Dundalk and Melville, some shopping

centres provide wheelchairs for their

customers and have wheelchair access. In

Melbourne, the need to walk long distances

is seen as a barrier to using large shopping

centres. In Istanbul, shopping centres have

escalators but older people fi nd them diffi

cult to use.

It is considered that buildings, including

shops, should be located close to where

older people live to enable them to have

easy access to these services and facilities.

Older people in Tuymazy appreciate living

close to stores and markets. Th e clustering

of businesses in Sherbrooke allows older

people to do their transactions within a

small radius of their homes.

Th e availability of clean, conveniently located,

well-signed, handicap-accessible toilets

is generally regarded as an important agefriendly

feature of the built environment. In

Islamabad, appreciation is expressed for the

recently introduced public toilets, which

are increasing in number.

A number of barriers are identifi ed in relation

to public toilets. In Halifax, it is noted

that the toilet doors are heavy. In Himeji,

public toilets are small and not all are the

type with seats. In La Plata, caregivers point

out that there are no toilets accessible to

people with disabilities.

Good customer service that appreciates the

needs of older people is considered to be an

age-friendly feature. Preferential treatment

is given to older people in Cancún, and in

Jamaica, some businesses provide wheelchairs

for older customers. In Mexico City,

priority service is provided to older people

by law. In Portland, an “elderly-friendly”

business guide and audit system has been

developed by a voluntary group.

One of the barriers identifi ed in a number

of cities is the long queues or waiting times

older people face to be served. It is suggested

that special service arrangements

be made for older people, such as separate

queues or service counters. Older people in

Islamabad recommend giving older women

priority in queues. In Sherbrooke, it is suggested

that seats be placed in businesses,

such as banks, where older people are

required to wait.

Another barrier identifi ed in some cities,

including London and Tokyo, is the disappearance

of the local shop or convenience

store. With their closing, older people lose

a potential source of social contact and are

required to travel further to shop.

PAGE 18

• Th e city is clean, with enforced regulations

limiting noise levels and unpleasant

or harmful odours in public places.

• Th ere are well-maintained and safe green

spaces, with adequate shelter, toilet

facilities and seating that can be easily

accessed.

• Pedestrian-friendly walkways are free

from obstructions, have a smooth surface,

have public toilets and can be easily

accessed.

• Outdoor seating is available, particularly

in parks, transport stops and public spaces,

and spaced at regular intervals; the

seating is well-maintained and patrolled

to ensure safe access by all.

• Pavements are well-maintained, smooth,

level, non-slip and wide enough to accommodate

wheelchairs with low curbs

that taper off to the road.

• Pavements are clear of any obstructions

(e.g. street vendors, parked cars, trees,

dog droppings, snow) and pedestrians

have priority of use.

• Roads have adequate non-slip, regularly

spaced pedestrian crossings ensuring that

it is safe for pedestrians to cross the road.

• Roads have well-designed and appropriately

placed physical structures, such as

traffi c islands, overpasses or underpasses,

to assist pedestrians to cross busy roads.

• Pedestrian crossing lights allow suffi cient

time for older people to cross the road

and have visual and audio signals.

PAGE 19

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

• Th ere is strict enforcement of traffi c rules

and regulations, with drivers giving way

to pedestrians.

• Th ere are separate cycle paths for cyclists.

• Public safety in all open spaces and

buildings is a priority and is promoted

by, for example, measures to reduce the

risk from natural disasters, good street

lighting, police patrols, enforcement of

by-laws, and support for community and

personal safety initiatives.

• Services are clustered, located in close

proximity to where older people live and

can be easily accessed (e.g. are located on

the ground fl oor of buildings).

• Th ere are special customer service arrangements

for older people, such as

separate queues or service counters for

older people.

• Buildings are accessible and have the following

features:

– elevators

– ramps

– adequate signage

– railings on stairs

– stairs that are not too high or steep

– non-slip fl ooring

– rest areas with comfortable chairs

– suffi cient numbers of public toilets.

• Public toilets are clean, well-maintained,

easily accessible for people with varying

abilities, well-signed and placed in convenient

locations.

PAGE 20

Part 6. Transportation

Transportation, including accessible and

aff ordable public transport, is a key factor

infl uencing active ageing. It is a theme running

through many other areas of discussion.

In particular, being able to move

about the city determines social and civic

participation and access to community and

health services.

People consulted in the WHO project

therefore have a lot to say on the topic, covering

every aspect of infrastructure, equipment

and service for all means of urban

transportation.

Service provider, Dundalk

Public transport services are said to be

available in almost all of the cities, although

not in all areas. Cities in developed countries

and those with a transition economy

(e.g. the Russian Federation) are more

likely to indicate that their public transport

system is well-developed or satisfactory. A

range of transport services are available in

many cities, including buses (private and

public), trains, trams, trolleybuses, rickshaws

(private and public), shuttle buses

and minibuses, community (voluntary)

transport services, services specifi cally for

disabled or frail older people, taxis, and

personal drivers. Yet in cities at all stages of

development, there are gaps reported that

need to be addressed to make the community

more age-friendly.

Cost is viewed as a signifi cant factor aff ecting

older people’s use of public transport.

In some cities, free or subsidized public

transport for older people is said to be provided.

Geneva reportedly off ers free transport

for someone accompanying an older

person, and in Dundalk, people 75 years

and older are entitled to a Companion Pass.

In some cities, however, the cost of public

transport is considered to be too expensive.

Older people in Nairobi complain about the

arbitrary price increases charged because of

bad weather, public holidays and peak travel

periods. Diffi culties getting subsidized or

free fares are mentioned. In Himeji, it is

said that the eligibility age for the complimentary

pass is too high, while in New

Delhi, the application process for concession

travel is considered to be cumbersome.

In Rio de Janeiro, free transport is not

provided to the older people who live in the

favela, as public transport does not service

this area. In Geneva, discounted travel can

only be obtained if older people purchase a

21

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

not be used for private transport services

in some cities, although in Dundalk, free

travel passes are accepted on some private

bus services.

People in some cities suggest that free

transport or subsidized transport be

provided or extended for older people. In

Mexico City, it is suggested that free transport

be provided for older people to attend

specifi c events.

Having frequent and reliable public transport

services is identifi ed as an age-friendly

feature. Some older people, especially in developed

countries, indicate that the frequency

of their city transport services is good.

Nevertheless, there are a number of reports

from cities at varying stages of development

that public transport services are not

frequent or reliable enough. In Istanbul,

older people indicate that travelling by

public transport takes a very long time

as it is not frequent. In Melbourne, some

areas are said to have no bus service from

Saturday afternoon until Monday morning.

In the Ruhr metropolitan area, older people

consider that public transport to the outer

areas of the city and at night is not frequent

enough. In some cities, it is suggested that

public transport be more frequent, particularly

at night and at weekends.

In a few cities, such as Geneva, London,

Moscow and Tokyo, people indicate that

their public transport services are reliable

but this is not always the case in other

similarly developed cities. Th is was not an

age-friendly feature reported in developing

cities. In Amman, there is no fi xed

timetable for the buses, and in Islamabad,

there is no fi xed timetable for public service

vehicles. In La Plata, the buses are unreliable

as the routes are often changed.

Th e ability to use public transport depends

very much on being able to get to where

you want to go. People in quite a few cities

state that their public transport services

provide good coverage of at least some areas,

enabling people to get to their desired

destination. But concern is expressed in

other cities in both developed and developing

countries about the adequacy of public

transport routes; people complain that several

areas of the city are not covered, or it is

diffi cult to cross the entire city, or there are

poor connections between buses and other

means of transport. In addition, important

destinations of older people are not wellserved.

For instance, the bus in Dundalk

does not travel to one of the nursing homes,

and in Mayaguez, there is limited transportation

to the seniors’ centres. In Tuymazy,

access by public transport to public gardens

is considered insuffi cient.

PAGE 22

Older person, Portland

Boarding and disembarking from vehicles is

another major issue raised. A number of cities

are reported to have some public transport

vehicles that are modifi ed to provide

easier access for older people: in Shanghai,

modifi ed seating is provided; in Saanich,

there are some accessible buses; and in

Udaipur, a public bus service is starting soon

with low-fl oor buses. In Geneva, some buses

have raised platforms and low fl oors.

People commonly observe that the design

of public transport vehicles presents barriers

to older people. In Udine, for example,

the older people say that it is diffi cult to use

buses owing to the high steps on the buses,

and in Ponce, buses are not adapted for

wheelchair access.

Residents in a small number of cities also

mention other features that discourage

the use of public transport. In New Delhi,

older people point out that the bus route

numbers are not clearly displayed on public

service buses. Th e service providers in

Dundalk question the roadworthiness of

some buses, and in La Plata, older people

express concern about the deteriorated

condition of some buses.

Older people who have diffi culties using

public transport need to have specially

adapted means of transport. Th ese are

mentioned as an age-friendly feature in

some cities in developed countries, but in

others there are few such options available.

Recommendations are made to provide

services for people with disabilities. For

example, in Rio de Janeiro, caregivers mention

that taxis are the only available means

of transport for older people with disabilities,

but that their wheelchairs cannot fi t

into the boot of the vehicle because the

petrol tank is located there. In Mexico City,

caregivers suggest the provision of adapted

buses specifi cally for disabled people and

their caregivers.

A few cities indicate that having priority

seating on public transport for older people

is an age-friendly feature and in some cities,

such as Islamabad, passengers do respect

the priority seating for older people. Th is

courtesy is not common, however, and public

education on courtesy in public transportation

is recommended by, for example,

older people in Moscow.

In some cities, courteous transport drivers

are described as an age-friendly feature

facilitating the use of public transport. In

many others, however, concern is expressed

about the insensitivity of drivers, particularly

bus drivers, towards older people.

PAGE 23

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

One of the major concerns raised is that

drivers do not wait for older people to be

seated before starting off .

Older person, Saanich

In Rio de Janeiro, it is pointed out that

many middle class older people take a taxi

or the metro rather than ride in a bus, because

they are afraid of falling in a bus.

A particular problem identifi ed in developing

cities, such as Amman, is drivers’

reluctance to pick up older people. In Delhi

and Geneva, older people highlight the

diffi culties caused when bus drivers do not

stop close enough to the curb to enable

them to get on and off the bus safely. People

in Dundalk mention that bus drivers stop at

unmarked locations, which is often dangerous,

particularly at road corners. In Geneva

and Ponce, some bus drivers are said to be

to be impolite.

Other identifi ed barriers include careless driving

and disregard for the rules of the road.

Older person, Mexico City

A fi nal issue identifi ed in a few developing

cities is exploitation by drivers. For

example, in New Delhi, some rickshaw

drivers overcharge their passengers, and in

Nairobi, fares are changed very arbitrarily.

Not surprisingly, in quite a few cities it is

suggested that drivers should be educated

to be sensitive to the needs of older people.

Th e driver training programme that has

been implemented in Sherbrooke is regarded

as a benefi t for older passengers.

In a small number of cities, it is suggested

other transport staff , for example counter

staff , should also be educated about the

needs of older people and how this aff ects

their use of transport services.

Whether or not people feel safe using public

transport has a signifi cant eff ect on their

willingness to use these services. In a few

cities, it is reported that public transport is

safe. In Cancún it was mentioned that there

is less crime on public transport services

than in other cities, and in Melbourne and

Moscow, public transport is deemed to be

safe. Yet even in places where some people

consider public transport safe to use, for

example London, it is still suggested that

steps be taken to further improve safety. In

the many cities where reservations about

the safety of public transport are expressed,

the issues are theft or antisocial behaviour.

PAGE 24

Older person, Istanbul.

In many cities, crowded public transport,

particularly during peak times (the “rush

hour”), also presents safety issues for older

people. Th is problem is more commonly

identifi ed in developing cities and in the

Russian cities. For example, in Jamaica,

pushing and shoving is reported to be a

problem for older people at bus stops and

on boarding buses. In Moscow, it is pointed

out that crowding makes it diffi cult to

breathe in the railway station.

A few developed cities, like Dundalk,

Portland and Saanich, also mention diffi

culties related to overcrowded public

transport.

Older person, Dundalk

In Nairobi, older people note with satisfaction

that overcrowding problems have

signifi cantly improved since the introduction

of legislation, the Michuki Rules, to

ensure the required seating capacity is not

exceeded. In Tuymazy, providing more

buses during peak times is suggested, while

in Saanich, it is recommended that older

people be encouraged to use public transport

outside peak times.

Th e design, location and condition of

transport stops and stations are signifi cant

features as well. In Shanghai, older people

and caregivers value the benches, shelter

and lighting provided at some transport

stops. In Ponce, the bus stops and terminal

are kept in good condition. In Portland,

convenient access to transport stops is

viewed with satisfaction.

Th e location of transport stops presents

some diffi culties for older people. Problems

are encountered in Melbourne when there

are few bus stops and the distance between

the stops is too great. In Melville, older

people express concern about having to

cross a major road to get to the bus stop. In

Saanich, some older people mention that

bus stops are too far from their homes.

In some cities, there are issues of safety at

transport stops. In Moscow, it is reported

that there are pickpockets in the crowds

at the transport stops, and in Melbourne,

there are complaints about vandalism at

bus stops. In Melville, a programme by

which children decorate bus stops is believed

to have reduced vandalism.

In San José, the lack of shelter at transport

stops is perceived as a disadvantage, as is

the lack of seating at transport stops in

Shanghai. In Tokyo, however, it is pointed

out that placing benches at bus stops makes

it diffi cult for people with disabilities to

walk around them, because the streets are

very narrow.

PAGE 25

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

People in many cities consider that railway

stations and bus terminals should be easy

to get to and should have an age-friendly

design with ramps, escalators, elevators,

public toilets and clearly visible signage. In

Tokyo, older people and caregivers value

the lift that was installed in the metro

station. In the Ruhr metropolitan region,

older people consider the lack of facilities

as the main railway station to be a barrier

to transporting luggage and wheelchairs

up to the platforms. In New Delhi, older

people point out that the metro station is

not located close to where they live and that

signage at the station is inadequate.

Taxi services are viewed as an age-friendly

transportation option in a number of cities.

In Cancún, taxis are considered to be

aff ordable. In Dundalk, older people value

the discounted fares provided by taxi

services. In Melville, caregivers appreciate

the government subsidy scheme for the use

of taxis. In Halifax, it is said that some taxi

drivers are very helpful to older people, and

in Tripoli, it is reported that taxis provide a

good and convenient service.

In other cities, barriers are identifi ed in the

use of taxis. Cost is one barrier and lack of

disability access is another. In Portage la

Prairie, caregivers are concerned that taxi

drivers will not take wheelchair customers.

In Halifax, the design of the taxi is a problem

because there is no room to transport a

walking frame. In Tuymazy, it is suggested

that taxis should have large boots to accommodate

wheelchairs.

Th e availability of community transport

services (i.e. free transportation provided

by the voluntary or private sector)

is considered to be an age-friendly service

more often mentioned by people in developed

than in developing cities. In Ponce,

for example, there is free transportation

provided by seniors’ centres to attend medical

appointments, and in Portage la Prairie

community volunteer drivers and the

shuttle service provided by grocery stores

are valued services. In London, a suggested

service is community transport with fully

accessible buses and drivers trained to

serve older people.

In a few cities, there is mention of the

importance of having information on

transport options, on how to use transport

services, and on timetables. In Portland, for

example, programmes are provided to teach

older people how to use public transport.

In Melville, it is suggested that older people

who can no longer drive be off ered a course

on how to use public transport. In Himeji,

it is suggested that bus timetables indicate

whether the bus is one that is accessible to

people with disabilities. Older people in

Tokyo identify the need for timetables to be

in larger print and conveniently located.

PAGE 26

Driving as an essential transportation option

for older people is discussed in a few

locations. For example, it is observed that

Melville is a city designed for cars, and in

Himeji, cars are considered a necessity in

the suburbs. In Ponce, cars are viewed as

necessary because of the limited transport

options available.

People in a few cities indicate that it is easy

to drive around the city, a feature more

likely to be mentioned by those in developed

countries. In Portage la Prairie, the

traffi c is said to be light and driving easy.

In Saanich, the older people appreciate the

advance warnings of crossroads. In Tokyo,

older people mention that the road signals

and signs are easy to see. Th e streets of

Tripoli are considered to be well-marked,

and in Shanghai, the traffi c management is

viewed as good.

People in many more cities in countries at

all stages of development report barriers

to city driving. Th ese include heavy traffi c,

poor condition of roads, ineff ective traffi c

calming devices, inadequate street lighting,

inadequate signage that is obscured

or poorly positioned, and the disregard for

traffi c rules and regulations. For example,

in Rio de Janeiro, the heavy traffi c is viewed

as a barrier. In Cancún the older people

complain that the roads have holes and are

generally in a bad condition. In Melville,

concerns are raised about ineff ective traffi

c calming devices such as roundabouts,

which are either too small or are placed in

inappropriate places. In Mayaguez, older

people report that streets are not well-lit. In

Halifax, the street signage is considered too

small, too high and often obscured. Older

people in Udine report that drivers do not

respect traffi c regulations. In Sherbrooke,

other drivers are said to be often aggressive.

In addition to the barriers identifi ed above,

the disrespect shown to older drivers discourages

a number of them.

Older person, Tripoli

In La Plata, it is stated that older drivers

are abused because they drive too slowly.

In Cancún, older people feel unsafe when

driving owing to their own vision problems

and the aggressive traffi c. In Tuymazy, service

providers comment that older people

are not confi dent driving on the roads.

PAGE 27

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

In some cities, such as Portage la Prairie,

where driving is an essential transport option,

concerns are raised about the diffi culties

that older people face when giving up

their licences. To ensure older people are

confi dent drivers, refresher courses are recommended

in some cities such as including

Geneva and Portland. Th e special lessons

given to older people in Himeji when they

need to renew their licence is viewed as an

age-friendly advantage.

Priority parking bays for older and handicapped

people in close proximity to buildings,

together with drop-off and pick-up

bays, were seen as age-friendly features.

In Amman, older people value the bays

for the handicapped provided by stores. In

Dundalk, free parking is appreciated. In

Portage la Prairie, the large car park is considered

an age-friendly asset for drivers.

In many cities, however, inadequate and

costly parking facilities are identifi ed as

barriers for older people. Other problems

are mentioned too. In Mayaguez, it is said

that there are not enough drop-off and

pick-up points for older people with disabilities,

while in Portage la Prairie, it is

pointed out that the parking bays are not

wide enough for loading wheelchairs. In

Saanich, the lack of handicap parking bays

is raised as an issue. In Melbourne, concern

is expressed about the inability to

fi nd parking close to buildings. One other

concern expressed is the lack of respect for

priority handicap parking bays.

Older person, London

PAGE 28

• Public transportation is aff ordable to all

older people.

• Consistent and well-displayed transportation

rates are charged.

• Public transport is reliable and frequent

(including services at night and at weekends).

• Public transport is available for older

people to reach key destinations such as

hospitals, health centres, public parks,

shopping centres, banks and seniors’

centres.

• All areas are well-serviced with adequate,

well-connected transport routes within

the city (including the outer areas) and

between neighbouring cities.

• Transport routes are well-connected

between the various transport options.

• Vehicles are accessible, with fl oors that

lower, low steps, and wide and high seats.

• Vehicles are clean and well-maintained.

• Vehicles have clear signage indicating the

vehicle number and destination.

• Suffi cient specialized transport services

are available for people with disabilities.

• Priority seating for older people is provided,

and is respected by other passengers.

• Drivers are courteous, obey traffi c rules,

stop at designated transport stops, wait

for passengers to be seated before driving

off , and park alongside the curb so that

it is easier for older people to step off the

vehicle.

• Public transport is safe from crime and is

not overcrowded.

• Designated transport stops are located

in close proximity to where older people

live, are provided with seating and with

shelter from the weather, are clean and

safe, and are adequately lit.

• Stations are accessible, with ramps, escalators,

elevators, appropriate platforms,

public toilets, and legible and well-placed

signage.

• Transport stops and stations are easy to

access and are located conveniently.

• Station staff are courteous and helpful.

PAGE 29

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

• Information is provided to older people

on how to use public transport and about

the range of transport options available.

• Timetables are legible and easy to access.

• Timetables clearly indicate the routes of

buses accessible to disabled people.

• Community transport services, including

volunteer drivers and shuttle services, are

available to take older people to specifi c

events and places.

• Taxis are aff ordable, with discounts or

subsidized taxi fares provided for older

people with low incomes.

• Taxis are comfortable and accessible,

with room for wheelchairs and/or walking

frames.

• Taxi drivers are courteous and helpful.

• Roads are well-maintained, wide and

well-lit, have appropriately designed and

placed traffi c calming devices, have traffi c

signals and lights at intersections, have

intersections that are clearly marked,

have covered drains, and have consistent,

clearly visible and well-placed signage.

• Th e traffi c fl ow is well-regulated.

• Roads are free of obstructions that might

block a driver’s vision.

• Th e rules of the road are strictly enforced

and drivers are educated to follow the

rules.

• Refresher driving courses are provided

and promoted.

• Aff ordable parking is available.

• Priority parking bays are provided for

older people close to buildings and transport

stops.

• Priority parking bays for disabled people

are provided close to buildings and transport

stops, the use of which are monitored.

• Drop-off and pick-up bays close to buildings

and transport stops are provided for

handicapped and older people.

PAGE 30

Part 7. Housing

Housing is essential to safety and well-being.

Not surprisingly, people consulted

by WHO in all regions have much to say

on diff erent aspects of housing structure,

design, location and choice. Th ere is a link

between appropriate housing and access to

community and social services in infl uencing

the independence and quality of life of

older people. It is clear that housing and

support that allow older people to age comfortably

and safely within the community

to which they belong are universally valued.

Th ere is general agreement among the cities

that the cost of housing is a major factor

infl uencing where older people live and their

quality of life. While in some cities the cost

of housing, including rent, is considered to

be aff ordable, in others housing is regarded

as expensive, making it diffi cult for older

people to move to more appropriate housing.

Older person, Istanbul

For example, in Geneva it is reported that

some older people are living in houses that

are too big for them but, because they are

pensioners, they cannot aff ord to move.

Similarly, in Tuymazy, it is stated that the

cost of moving house is too expensive and

not possible for retirees. Free or low-cost

public housing is regarded as a defi nite agefriendly

advantage in some cities, such as

London. In other cities, such as Islamabad,

the lack of low-income housing is seen as

a barrier. Th e need to have information

about subsidized housing is highlighted in

Portage la Prairie.

Older person, London

In cities in countries at all stages of development,

it is recommended that aff ordable

housing be available for older person. Ideas

include a lower level of tax on housing for

older people in Amman, and having a housing

subsidy for public and private housing

in Himeji.

PAGE 31

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

In a small number of cities, essential services

are found to be inadequate or very

expensive. In Islamabad, houses in lowincome

areas have no electricity, gas or

water supply. In Moscow, the public utility

services are considered to be expensive.

In Dundalk and Istanbul, older people are

concerned by the high costs of heating and

think that the government should assist

with heating costs. In Jamaica, older people

on a low income fi nd it diffi cult to pay the

high utility costs and suggest that these

costs should be reduced.

Older person, Jamaica

In Rio de Janeiro, older people value the improvements

that have been made in water,

sanitation and electricity services, and in

Istanbul, the older people appreciate the

good water supply.

Several aspects of housing design are considered

to aff ect the ability of older people

to live comfortably at home. In general, it

is considered important for older people to

live in accommodation that is built from

adequate materials and structurally sound;

has even surfaces; has an elevator if it is

multi-level accommodation; has appropriate

bathroom and kitchen facilities; is large

enough to move about in; has adequate

storage space; has passages and doorways

large enough to accommodate a wheelchair;

and is appropriately equipped to meet the

ambient environmental conditions.

Problems with housing construction are

mentioned in a few cities. In Mexico City,

people identify the need for supervised

construction to ensure that the housing is

structurally sound. Poverty is said to result

in poorly constructed or maintained housing

in Istanbul, and in Nairobi, the lack of

available construction materials is a source

of concern. In Islamabad, some housing is

not earthquake-proof.

A number of structural features are identifi

ed as barriers. Home layout that impedes

mobility is a problem identifi ed in Dundalk.

In La Plata, stairs and uneven fl oors are experienced

as barriers. In Moscow, the need

for purpose-built bathrooms and toilets for

older people is reported. In New Delhi, it is

considered that kitchens need to be better

designed. In Mexico City, the need to have

railings and elevators in multi-level buildings

is mentioned, and people in Tokyo

point out the need for passages and doorways

to accommodate wheelchairs.

In a small number of cities, housing is not

appropriately equipped for the weather

conditions. In particular, air-conditioning

is a reported need in Cancún and in some

areas of Melville, where the roof design of

new houses makes it hotter inside.

PAGE 32

In many cities, there is recognition of the

measures that have been taken to improve

housing design to accommodate older

people. In Mexico City, for example, 1% of

all houses built must be suitable for older

people. In Halifax, some condominiums

are age-friendly and have access ramps,

elevators, parking, gym facilities and wide

doorways.

Nevertheless, people frequently feel that

more needs to be done to ensure housing

is appropriate for older people. In Himeji,

more age-friendly housing is recommended,

while in Melbourne, incentives to

encourage architects and property developers

to build age-friendly housing are suggested.

People in New Delhi recommend

that age-friendly features be incorporated

into building by-laws. In Saanich, builders

include adapted or adaptable features into

their plans, such as lower placement of light

switches, installation of showers rather

than bathtubs, and stairways that can be

converted to accommodate a chairlift.

Th e ability to modify one’s house or

apartment also aff ects the ability of older

people to continue to live comfortably at

home. Caregivers in Dundalk appreciate

the chairlifts that were installed to assist

older people. In Mayaguez, apartments for

disabled older people have the adaptations

required. In a small number of cities, such

as Himeji and Dundalk, fi nancial assistance

is provided for home modifi cations.

A number of diffi culties are identifi ed in

relation to home modifi cations. In Halifax,

retrofi tting a home is considered to be expensive

and diffi cult. Restrictions on the remodelling

of public housing are mentioned

in Himeji and New Delhi. In Portland,

rented accommodation that has been

remodelled is required to be returned to its

original state. In Melbourne, it is pointed

out that assistance equipment is not used

because it does not fi t into the home and

many caregivers are unable to aff ord the

necessary renovations. In Sherbrooke, the

need to adapt housing for specifi c conditions

is mentioned.

Besides identifying the need to ensure older

people are aware of the possible options

for modifying their homes, it is suggested

in many cities that older people need to

be able to obtain the necessary equipment.

In Tuymazy, caregivers identify their

need for information on diff erent types of

equipment and possible adaptations and

on equipment that is easy to obtain. In

Udaipur, diffi culties in obtaining hand rails,

ramps and toilets are mentioned.

Being unable to maintain one’s home is as

a major barrier for some older people. In

Cancún, older people say they are unable

to make repairs owing to the cost involved.

In Melbourne, they are likewise concerned

about costs of maintenance and suggest

that the local municipality provide a home

maintenance service for a nominal fee. In

Rio de Janeiro, the high cost of condominium

maintenance fees is considered to be a

PAGE 33

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

barrier, although it is pointed out that it is

possible to sublet condominiums to assist

with the cost of the maintenance fees.

In Dundalk, the older people value the

grants provided for home repairs but complain

about diffi culties in organizing the

service people to undertake the repairs.

Older person, Dundalk

In Melville, concern is raised about having

strangers coming into the home to do

maintenance work, and it is suggested that

the local municipality maintain a list of dependable

repair services that are prepared

to deal with older people. In Portland,

caregivers appreciate the system used for

screening contractors and other repair and

maintenance services.

Problems are also identifi ed regarding the

maintenance provided in public housing

and rented accommodation. In London,

concern is raised about repairs not being

done in a timely manner. In Tripoli, older

people indicate that landlords purposely

neglect maintenance so that the older

people leave. In Delhi, it is reported that

common areas like staircases are often

neglected, dirty and dark.

Nevertheless, staff in collective dwellings,

such as concierges and caretakers, sometimes

play an important role in ensuring

well-being. In Geneva, the older people

mentioned the importance of the concierge

in establishing contact among residents and

taking care of repairs.

Th e provision of services to older people

in their homes is particularly important.

In Udine, it is stated that older people do

not consider moving house. In Tuymazy,

the service providers similarly indicate

that older people are very attached to

their homes and do not want to move. In

Saanich, receiving home assistance is considered

preferable to moving house.

In a few cities, diffi culty in obtaining

services at home, including their cost, is

considered a disadvantage. In the Ruhr

metropolitan region, services such as cleaning

and gardening are seen to be scarce and

expensive. Older people in Saanich report

that there are not enough cleaning and

gardening services available.

Living close to services and facilities is also

seen as an age-friendly feature. Th is is more

commonly mentioned by people in cities

in developed countries, such as Melville,

Portage La Prairie and Tokyo. In San José,

older people valued living in close proximity

to public, commercial and religious services.

In a number of cities, such as Nairobi,

Udaipur and Udine, not living in close proximity

to such services is seen as a problem.

PAGE 34

Nevertheless, caution is also expressed

about remaining at home and being unable

to look after oneself adequately. In Mexico

City, the need to educate older people about

the risks of living at home is raised, and in

Saanich, the idea is advanced on providing

information on home services for older

people by publishing a directory of home

support services

Familiar surroundings, whereby people feel

part of the local community, contribute

to the age-friendliness of a city. For this

reason, older people are reluctant to move.

In Udine, older people mention they have

a kind of “psychological safety” in their

environment. In Tripoli, older people highlight

the importance of their neighbours. In

Dundalk, service providers recognize the

need to locate new homes close to where

older people have lived in order to retain

links with family and the community. In

Himeji, concern is expressed that older

people lose their connection with the community

when they move to another facility.

Changes to the city aff ect these feelings of

familiarity with the community. In Tokyo,

the lack of personal contact with neighbours

that results from the development of

high-rise buildings is regarded as an agefriendly

barrier. In Sherbrooke, older people

express concern about the lack of multigenerational

spaces for interaction. In Geneva,

the lack of contact with younger people in

apartment buildings is seen as a disadvantage.

In Udaipur, caregivers are concerned

that modern fl ats without front verandas

leave no room for community interaction.

Th e importance of design that facilitates

community interaction is mentioned in

Dundalk as well, where it is suggested that

houses should overlook communal facilities

to reduce the sense of isolation.

A range of housing options in the local area

to accommodate changing needs is regarded

as an important age-friendly feature.

In some cities, there are a number of such

housing options. In Melville, for example,

older people have the choice of moving into

smaller accommodation, seniors’ housing

or care facilities. In many locations, however,

the need for more housing options

for older people is stressed. In Halifax, for

example, it was mentioned that some older

people were concerned about not being able

to fi nd accommodation in their local area

and did not have good knowledge about the

housing options in their area.

In some cities, dedicated seniors’ housing

options are provided. In Melville, seniors’

housing complexes provide a range of services,

amenities and activities.

Older person, Melville

PAGE 35

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Dedicated seniors’ housing seems to be in

short supply in many cities and waiting

times can be long, as mentioned in Halifax

and Himeji. Seniors’ housing also needs

to be aff ordable to be age-friendly. Older

people in Saanich express concern about

the cost of seniors’ housing. Th ere is also a

clearly expressed preference in a few cities

for seniors’ housing to be integrated into

the local community. In Melville, it is suggested

that small clusters of seniors’ housing

with small gardens be made available

throughout the city, so that older people

are not isolated from the community and

particularly from children. In Portland,

the need for multigenerational housing is

identifi ed. In the Ruhr metropolitan region

and Sherbrooke, concern is expressed about

creating ghettos of older people in large

seniors’ housing complexes.

It is important for older people to have

suffi cient space and privacy at home.

In a handful of developing cities and in

Tuymazy, overcrowding is identifi ed as a

barrier for older people. In Delhi, for example,

as the average family size has increased

houses have become overcrowded and older

people do not have suffi cient space. In San

José, overcrowding has resulted from the

high housing costs that forces family members

to live together.

Feeling safe in the home environment is

another theme. In many cities, older people

feel insecure and particularly fear living

alone. Measures have been taken in some

cities to improve the security in older

people’s homes. In Dundalk, for example,

surveillance cameras are used in some

homes; in Geneva, there is secure access

to apartment buildings; in Saanich, older

people are provided with free home security

checks; and in Shanghai, there is a local

security patrol. In Himeji, some apartments

have emergency call monitoring devices to

keep older people safe.

Nevertheless, there is an expressed need for

more to be done to ensure that older people

feel secure at home. In Udaipur, more

information about home security is recommended,

and in Saanich, it is suggested that

emergency alarms be installed.

In some cities, the homes of older people

are not located in environments that are

safe from natural disasters. In La Plata,

some homes are in fl ood-prone areas, and

in Islamabad, older people are concerned

about earthquakes.

PAGE 36

• Aff ordable housing is available for all

older people.

• Essential services are provided that are

aff ordable to all.

• Housing is made of appropriate materials

and well-structured.

• Th ere is suffi cient space to enable older

people to move around freely.

• Housing is appropriately equipped to

meet environmental conditions (e.g. appropriate

air-conditioning or heating).

• Housing is adapted for older people, with

even surfaces, passages wide enough for

wheelchairs, and appropriately designed

bathrooms, toilets and kitchens.

• Housing is modifi ed for older people as

needed.

• Housing modifi cations are aff ordable.

• Equipment for housing modifi cations is

readily available.

• Financial assistance is provided for home

modifi cations.

• Th ere is a good understanding of how

housing can be modifi ed to meet the

needs of older people.

• Maintenance services are aff ordable for

older people.

• Th ere are appropriately qualifi ed and

reliable service providers to undertake

maintenance work.

• Public housing, rented accommodation

and common areas are well-maintained.

PAGE 37

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

• Housing is located close to services and

facilities.

• Aff ordable services are provided to enable

older people to remain at home, to

“age in place”.

• Older people are well-informed of the

services available to help them age in

place.

• Housing design facilitates continued

integration of older people into the community.

• A range of appropriate and aff ordable

housing options is available for older

people, including frail and disabled older

people, in the local area.

• Older people are well-informed of the

available housing options.

• Suffi cient and aff ordable housing dedicated

to older people is provided in the local

area.

• Th ere is a range of appropriate services

and appropriate amenities and activities

in older people’s housing facilities.

• Older people’s housing is integrated in

the surrounding community.

• Housing is not overcrowded.

• Older people are comfortable in their

housing environment.

• Housing is not located in areas prone to

natural disasters.

• Older people feel safe in the environment

they live in.

• Financial assistance is provided for housing

security measures.

PAGE 38

Part 8. Social participation

Social participation and social support

are strongly connected to good health and

well-being throughout life. Participating in

leisure, social, cultural and spiritual activities

in the community, as well as with the

family, allows older people to continue to

exercise their competence, to enjoy respect

and esteem, and to maintain or establish

supportive and caring relationships. It

fosters social integration and is the key

to staying informed. Yet the older people

consulted by WHO indicate clearly that the

capacity to participate in formal and informal

social life depends not only on the off er

of activities, but also on having adequate

access to transportation and facilities and

on getting information about activities.

Older person, Mexico City

In most cities, older people report that they

participate actively in their communities

but feel there could be more possibilities

for participation. Th ey suggest having more

and varied activities closer to where they

live. Th ey would like activities that foster

integration within the community and with

other age groups and cultures. Th e biggest

concerns are aff ordability and accessibility,

especially for people with disabilities, and

awareness of activities and events. Having

appropriate support in place to enable

accessibility, particularly for people with

mobility issues, is important everywhere,

and even more so in developing countries

and those with economies in transition.

Older people may be aware of events and

activities that exist in their community, but

in the experience of many participants in

the project these activities are inaccessible.

Personal safety, particularly at night, is

mentioned as one barrier in both developed

and developing cities, including Halifax,

La Plata, London and Rio de Janeiro. In

many cities, the locations are too distant

and transportation is diffi cult. Another

common problem is the accessibility of the

buildings, especially for people with impaired

mobility, and the lack of adequate

facilities such as toilets, appropriate seating

or smoke-free air. Another barrier mentioned

is restricted admission, such as the

requirement to be a member of an organization.

Caregiver, New Delhi

Eff orts in several cities to accommodate

older people are recognized by the older

people themselves and those who interact

PAGE 39

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

with them. Th e municipal government in

Mayaguez reportedly organizes a variety of

activities at hours that are suitable for older

people and provides transportation. An

older person in Geneva notes that amenities

are provided for people who are hard

of hearing. Th e availability of community

transport is reported from both Melbourne

and Melville, conveniently located activities

from Portland, and convenient timing

of events and activities from Tripoli.

Participants in Dundalk suggest that allowing

older people to bring a friend to events

would help them participate.

Activities that are free or at least affordable

facilitate participation by older

adults. Th e cost of activities is a frequently

mentioned problem, especially in cities

in developing countries and those with

economies in transition. In some areas,

a variety of options exist only for people

with adequate incomes, and recreation

and leisure activities are only available to

the rich. Participants in Islamabad note,

however, that participation in activities is

aff ordable. Rio de Janeiro off ers many free

leisure activities, and Mexico City has free

or low-cost cultural events. In Dundalk,

Geneva and London, it is mentioned that

because of high insurance costs, non-profi t

organizations are obliged to charge prices

for activities that they know may discourage

participation.

Th e existence of a variety of opportunities

that interest a broad range of older people

encourages more participation. Many cities

off er activities in major urban centres, but

fewer opportunities exist for people who

live outside those centres. Th ere may also

be fewer options for people who are frail

or disabled. Sometimes the schedules of

activities are rigid and older people need

to make a choice between meeting their

personal needs, such as a regular nap in the

afternoon, and participating in an activity.

Locations where activities do occur

may not appeal to older people because of

noise levels or an emphasis on youth programmes.

A variety of both targeted and

integrated activities provides a broad and

diverse range of choice for more people.

Th e range can include organized events

such as those in Himeiji, which are targeted

to people over 80. In Jamaica, older

people mention sporting events in which

older people can compete at various levels.

Portage La Prairie off ers communal meals

and social contact as part of the attraction.

Outdoor activities, such as a walk in a

garden in Nairobi and a fi ne-weather stroll

in Moscow, are seen as simple and low cost

ways of encouraging social participation

It is reported from Udine that buildings are

off ered to older people for activities such

as theatre, clubs, and Th ird Age University.

In Tuymazy, there is a chess club, a historical

re-enactment society and a club for the

over-60s. Participants from Cancún say

they enjoy a “golden age” club, craft classes

at the local monastery, and talks, music and

dancing. All of the larger cities in the developed

regions, and the majority of cities in

the developing countries, are said to off er a

variety of activities.

PAGE 40

Religious activities and socializing within

faith communities is an important form

of participation for older people in most of

the cities. Older people may be well-known

and esteemed within their local faith community.

Th ese communities are usually

welcoming and inclusive too, facilitating

participation by people who may be at risk

of becoming isolated. It is reported from

Halifax, for example, that churches contribute

to older people’s lives through activities

such as card games, group meals, drives to

church, and outreach to isolated people. In

Islamabad, it is noted that going to mosque

more than once a day contributes to social

participation.

Older person, Jamaica

Cultural, educational and traditional activities

also remain important to older people

in many locations. Continuing education

through Th ird Age Universities or through

courses at local community or seniors’

centres provides ongoing engagement and

learning. Going to weddings and funerals

are opportunities to socialize. Older people

in Islamabad report enjoying frequent traditional

events such as weddings.

Several participants point out that older

people need to know about activities and

opportunities in order to participate.

Service provider, Saanich

In Dundalk, it is reported that organizations

promote their activities by sending information

to older people before they retire.

People who attend religious services and

other scheduled activities regularly tend to

hear about other activities through word of

mouth. In San José, occupational associations

promote their activities. A service

provider in Shanghai suggests more older

people can be engaged if there is enough

publicity to attract participants.

A consistent message from cities around

the world is that social participation is

easier when the opportunities are close to

home and there are many of them. People

in La Plata are dissatisfi ed with the lack

of community centres in all neighbourhoods,

and in Udaipur, it is suggested that

community centres be provided within

distances that are walkable for older people.

Participants in Dundalk and Shanghai

advise using facilities in the community,

such as schools and recreation centres,

for all community members, including

older people. Th is suggestion is echoed in

Islamabad: a greater variety of leisure time

activities in more locations.

PAGE 41

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Concerted eff orts to encourage and motivate

older people to participate can

sometimes make the diff erence between

participation and isolation. Many people

who are involved with groups and clubs for

older people are very satisfi ed with their

activities. However, some people express

reluctance to join associations and clubs

for a variety of reasons: they may not know

anyone, they may feel that they have to associate

with a particular political view, or

they fi nd that the activities of that club are

not appealing.

Service provider, Himeji

Various reasons are given to explain why

isolated older people fi nd it more diffi cult

to associate with others. Th eir social contacts

have become eroded after the death

of their spouse and then gradually other

family members and friends. Th eir health

may be declining, limiting their ability to

participate. Owing to societal changes,

more women are in the workforce and

are therefore not at home during the day

to visit older people. Outreach to isolated

older people in their homes provides a

social connection and a way of encouraging

them to participate. In both Melbourne and

Shanghai, it is reported that organizations

take the initiative to seek out older people

and invite them to activities.

Service provider, Halifax

Caregivers, many of whom are older people

themselves, are particularly vulnerable to

feeling isolated because their world is so

centred on the person for whom they care.

Participants suggest more programmes and

options whereby older people with disabilities

can socialize outside the home without

requiring the presence of their caregiver.

Provision of day programmes and respite

options are suggested as ways of helping

older caregivers and their charges to continue

to connect with society.

Older person, Cancún

Th e lack of social participation by men is

raised in several cities, including Cancún

and Geneva. In some cities, nevertheless,

there are activities intended to appeal to

men: in Melville, for example, there is a

“Men’s Shed” off ering activities for men of

various ages. Older people in Istanbul mention

that mosques are good places for men

to participate in society. Participants in

Mexico City suggest more activities specifi -

cally for men, such as workshops or playing

dominos or cards.

PAGE 42

Some older people choose not to participate,

and respect for those who prefer to disengage

is advised by participants in Portland.

Older people want opportunities to socialize

and integrate with other age groups and

cultures in their communities, activities

and families.

La Plata, Argentina

Intergenerational activities are considered

to be more desirable than activities for

older people alone. Th ese opportunities can

be provided by sharing spaces and facilities,

such as in Saanich, where a seniors’

centre is located in an unused part of an

elementary school. In Ponce, some activities

involve older people in school settings.

Programmes provided at community and

recreation centres are suggested for encouraging

participation by people of diff erent

ages and levels of ability.

If older people are unable to participate in

activities outside of their homes, watching

television remains their only source of leisure

and connection with society. Th e need

to integrate options for all generations and

ages is refl ected in the concerns of older

people in some cities about the poor range

of programming choices available on television,

with little that appeals to them.

Older person, Udaipur

Older people in many areas want to participate

in their families in a meaningful way.

In Amman, for example, older people state

that they do not want to be isolated from

their families. However, families may not

give enough consideration to older people,

especially if there are expectations for

grandparents to care for grandchildren or

if there is little time to devote to activities

with or for an older family member.

Better integration of generations is seen as

a way to counter ageism in society, which

can also mar older people’s experience

when participating, or even discourage

their participation. Older people express

the desire for more public education about

their experiences and the reality of aging,

and consider that other generations would

be more patient and respectful if they understood

each other better.

PAGE 43

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Intergenerational opportunities enrich the

experience for all ages. Older people pass

on traditional practices and knowledge and

experiences, while younger people off er

information about newer practices and help

older people navigate in a rapidly changing

society. Older people in Nairobi are

engaged in traditional dances and skills,

enabling them to pass that knowledge to

others.

Caregiver, Nairobi

Th e constitution and design of a neighbourhood

can encourage the integration of

people from various backgrounds, ages and

cultures. Many neighbourhoods in cities

around the world are changing. Younger

people may not live in the same neighbourhood

as their older family members.

People may not have the same neighbours

throughout their lifetimes, and many cities

have growing populations of immigrants

who may not share the same language and

background as the majority population.

Older person, Istanbul

An open and welcoming neighbourhood

in the Ruhr metropolitan region provides

a basis for newcomers to integrate.

Newcomers in cities around the world are

at risk of becoming isolated, and older

people in this project recognize the need

to better integrate their activities to encourage

more participation by people from

other places and cultures.

Older person, Portland

Older person, Tokyo

PAGE 44

• Th e location is convenient to older people in

their neighbourhoods, with aff ordable, fl exible

transportation.

• Older people have the option of participating

with a friend or caregiver.

• Times of events are convenient for older

people during the day.

• Admission to an event is open (e.g. no

membership required) and admission, such

as ticket purchasing, is a quick, one-stop

process that does not require older people to

queue for a long time.

• Events and activities and local attractions

are aff ordable for older participants, with no

hidden or additional costs (such as transportation

costs).

• Voluntary organizations are supported by

the public and private sectors to keep the

costs of activities for older people aff ordable.

• A wide variety of activities is available to appeal

to a diverse population of older people,

each of whom has many potential interests.

• Community activities encourage the participation

of people of diff erent ages and cultural

backgrounds

• Gatherings, including older people, occur

in a variety of community locations, such as

recreation centres, schools, libraries, community

centres in residential neighbourhoods,

parks and gardens.

• Facilities are accessible and equipped to enable

participation by people with disabilities

or by those who require care.

• Activities and events are well-communicated

to older people, including information

about the activity, its accessibility and

transportation options.

• Personal invitations are sent to promote

activities and encourage participation.

• Events are easy to attend, and no special

skills (including literacy) are required.

• A club member who no longer attends

activities is kept on the club’s mailing and

telephone lists unless the member asks to be

taken off .

• Organizations make eff orts to engage isolated

seniors through, for example, personal

visits or telephone calls.

• Community facilities promote shared and

multipurpose use by people of diff erent ages

and interests and foster interaction among

user groups.

• Local gathering places and activities promote

familiarity and exchange among

neighbourhood residents.

PAGE 45

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Part 9. Respect and social inclusion

Older people report experiencing confl icting

types of behaviour and attitudes towards

them. On the one hand, many feel they are

often respected, recognized and included,

while on the other, they experience lack of

consideration in the community, in services

and in the family. Th is clash is explained in

terms of a changing society and behavioural

norms, lack of contact between generations,

and widespread ignorance about ageing and

older people. It is clear from the consultation

that the respect and social inclusion of

older people depend on more than societal

change: factors such as culture, gender,

health status and economic status play a

large role. Th e extent to which older people

participate in the social, civic and economic

life of the city is also closely linked to their

experience of inclusion.

Project participants primarily comment on

the behaviour of people towards them that

shows respect and courtesy, or the opposite.

As a whole, older people are respected

in the cities that have been studied: most

of the older people and other participants

in the focus groups recall the respect and

kindness expressed in everyday life towards

older adults.

Older person, Melbourne

In Jamaica and in Ponce, for example,

older people feel they are given priority

service in businesses and public places.

In Islamabad and Moscow, it is said that

people give up their seats on buses to older

adults. Examples of age-friendly services

are mentioned in some cities: in Portage

la Prairie, ballot papers are taken to the

homes of older people who are unable to go

to polling stations, and headsets are provided

in churches for people with hearing

impairments. In Mexico City, there is mention

of a bank whose employees are trained

to treat older people well, and at the end

of each month time is reserved exclusively

to serve older people. It is also reported

that in some businesses in Jamaica, older

people can sit and wait to be served directly

by employees assigned to the sitting areas.

Also, in Tokyo, older people note that businesses

treat them well because most customers

are older. In addition, older people

feel particularly respected and included in

seniors’ clubs. It is also noted that when

older people themselves are respectful

and pleasant, they often receive the same

response from others.

PAGE 46

Nevertheless, participants in several cities

also report disrespectful behaviour

towards older people. People are seen to

be impatient with older people who are

slower doing things, and rude gestures are

made towards older drivers. In Sherbrooke,

they feel they are treated like children.

Older adults in Amman also feel they are

criticized by young people for their different

clothes and way of talking. Some

young people are said to lack good manners

(Tokyo and Udine), not to give up their

seats on buses (Portland) and to be verbally

or physically aggressive towards older

people (Halifax, New Delhi and San José).

Older person, Melville

Commercial and professional services are

also said to be disrespectful or inconsiderate

of older people’s needs in some cities.

A caregiver in Amman noted that food in

restaurants is not suitable for older people.

Poor service in shops is noted in Melville.

In La Plata and Mayaguez, banks clerks

and employees in public agencies are said

to not listen to the needs and complaints

of older people. In San José, the example is

given of doctors having their prescriptions

prepared even before seeing older patients.

Other concerns about service providers are

expressed in, for instance, Nairobi, Ponce

and Saanich.

Service provider, Mayaguez

Suggestions for promoting age-friendly

services focus on training service providers

to understand how they can better respond

to the needs of older people.

In a society that glorifi es youth and change

in its popular imagery, the common negative

images of age and ageing are often

evoked to explain disrespectful behaviour.

Among the ageist biases reported, older

people are considered to be useless, less

intelligent, stingy and a burden. As a group,

there is a perception in developed countries

that they are demanding and a drain

on public resources. Older people who are

ill or who have disabilities are more likely

than those who are healthy to be viewed

negatively.

Older person, Tripoli

Disrespectful behaviour and ageism are

believed to result from ignorance of good

manners in some cities, the impersonality

of large and growing cities, the lack of

interaction between generations, and the

general lack of public knowledge about

PAGE 47

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

ageing and older people. In Melbourne and

New Delhi, it is also recognized that there

is a gap between contemporary norms of

individualism and the expectations of older

people.

Older person, Portland

In nearly all the cities in the project, participants

underlined the great need to

facilitate and organize encounters between

the generations, such as: working together;

participating in intergenerational planned

events; older people participating in civic

or historical education at school, or taking

care of children in public spaces; and young

people helping of old people on a voluntary

basis. Every solution that promotes intergenerational

activities is welcomed in most

cities. In Geneva, older people mention that

they themselves should take the fi rst step in

meeting the younger generation.

A common view is that public awareness

about ageing and its issues is greatly lacking,

and that education about ageing should

begin early and extend to all groups in

society.

Older person, Portage la Prairie

Many express the opinion that community

education should begin in primary school,

so that people learn cultural values and

to appreciate older people. In the view of

participants, education about ageing should

include acquiring some understanding of

the diffi culties caused by physical aging and

common impairments. As stated in Jamaica,

people would be able to prepare themselves

for that period of life by means of such education.

Almost all of the focus groups insist

on the importance of inculcating respect

for older adults; in Udaipur, summer camps

concentrating on social values are suggested

as a way to do this. Education about

ageing through age-friendly advertising in

the media is proposed as well; examples are

given in Melville of a television programme

showing a young person relating to an older

person, or of newspapers writing profi les of

local older people who have done a lot for

the community. Advertisements and posters

with attractive depictions of ageing are also

mentioned, as well as presentations of older

people in realistic and non-caricatured ways.

PAGE 48

Caregiver, Sherbrooke

Th e role that older people play in the community

contributes to the respect and inclusion

they enjoy. In a few cities, such as Moscow and

Tokyo, it is reported that they still maintain an

active local leadership role and have an impact

on public decisions. More often, however, participants

talk about the loss of these leadership

responsibilities, and even reluctance to listen

to advice from older people, as reported in

Melville. In Mayaguez, participants note that

the community is no longer used to taking

older people’s opinions into account, and now

even decisions concerning older people are

taken without consulting them.

Social engagement by older people positively

contributes to their esteem in the community.

Older people seem to be very often involved

in volunteer services, in which they may play

an active role, as in Halifax and Melbourne.

Some jobs are reserved for older people, such

as in the supermarkets in Cancún. In Himeji,

a programme called “Ask Older People” is

cited as an example of age-friendly inclusion:

this programme involves older people in

activities in which they have experience, such

as gardening, organizing events or talking at

elementary schools. In Saanich, programmes

that connect older people with schools are

reported.

Older adults are sometimes on committees

and boards of associations and organizations,

although in Sherbrooke it is said that

they still need to be better represented in

these areas. A point that is often raised is

that older people, their capacities and their

life experience have to be trusted and used

in decision-making. Th eir resources have to

be valued by the community, as suggested

in Dundalk and Mexico City. Service providers

in Portland add that older people can

be important eyes and ears of a community.

Older person, Portage la Prairie

Many comments concern the helpfulness

of people in the city towards older people

and the reasons why communities are more

or less inclusive. Smaller communities,

where people have lived for a long time and

know each other, are seen to be friendlier

and more inclusive: examples are Dundalk,

Portage la Prairie and the Copacabana district

of Rio de Janeiro.

Older person, Dundalk

PAGE 49

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

In other, larger cities, comments are made

to the eff ect that the city is “too big” and

impersonal, as in Istanbul. Neighbourhoods

are seen to not be cohesive in Islamabad

and Mexico City, and in London, the neighbours

seem to change so quickly that people

no longer have the time to meet and get to

know one another. Nevertheless, more inclusive

communities can be fostered. Some of

the focus groups propose promoting better

organized neighbourhoods with, for example,

local street committees (San José and

Tuymazy). Th e creation of places for neighbourhood

meetings is suggested in Istanbul;

this is reported to be already in place in La

Plata, where a part of the city hall is designated

for older people’s meetings.

In some cities, such as Amman and

Udaipur, it is considered an advantage

for older people to live with their family.

Remaining with the family signifi es being

cared for, having aff ection and maintaining

social status in the view of people

from Tripoli. In Udaipur, older people are

not only consulted by their families when

decisions are made, but their views are

accepted. Some older people mention that

they have left their community of origin to

go and live with their children in Cancún.

Family members are said to be helpful

and supportive, but at the same time it is

noted that family relationships are changing.

Comments are made, for instance in

Istanbul and New Delhi, that families are

more scattered because children move

away, and that younger generations do not

have much time to spend with older family

members. As a consequence, it is reported

from New Delhi that older people are

gradually marginalized in their own families.

In Islamabad, older people report that

older women are not always consulted in

family matters. In New Delhi, grandparents

are said to become reduced to the state of

servants of their grandchildren. In San José,

some families even require the grandparents

to work for money. Service providers in

a few cities mention problems of abandonment

or abuse of older people.

Older person, Tuymazy

In several countries, the majority of older

people have rather low incomes, and

poverty at any age excludes people from society.

In the Russian Federation, many older

people report that they feel excluded from

the society because of their low income:

retired people fully depend on the small

government allowances. It is reported in

Jamaica and Mexico City that people often

get very little personal fi nancial aid from

the government, and that there is too much

bureaucracy involved in obtaining entitlements.

In Cancún, older people say that

they do not feel included in government

programmes.

Older person, Mexico City

50

• Older people are consulted by public, voluntary

and commercial services on ways

to serve them better.

• Public and commercial services provide

services and products adapted to older

people’s needs and preferences.

• Services have helpful and courteous staff

trained to respond to older people.

• Th e media include older people in public

imagery, depicting them positively and

without stereotypes.

• Community-wide settings, activities

and events attract people of all ages by

accommodating age-specifi c needs and

preferences.

• Older people are specifi cally included in

community activities for “families”.

• Activities that bring generations together

for mutual enjoyment and enrichment

are regularly held.

• Learning about ageing and older people

is included in primary and secondary

school curricula.

• Older people are actively and regularly

involved in local school activities with

children and teachers.

• Older people are provided opportunities

to share their knowledge, history and

expertise with other generations.

• Older people are included as full partners

in community decision-making aff ecting

them.

• Older people are recognized by the community

for their past as well as their present

contributions.

• Community action to strengthen neighbourhood

ties and support include older

residents as key informants, advisers,

actors and benefi ciaries.

• Economically disadvantaged older people

enjoy access to public, voluntary and

private services and events.

ate the economic support adapted to the

economic condition of older people. Th is

includes an ID card allowing them access

to lower prices and even free services, and a

“Si Vale card” guaranteeing the poorest an

income of US$ 80 per month.

PAGE 51

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Part 10. Civic participation and

employment

Older people do not stop contributing to

their communities on retirement. Many

continue to provide unpaid and voluntary

work for their families and communities. In

some areas, economic circumstances force

older people to take paid work long after

they should have retired. An age-friendly

community provides options for older

people to continue to contribute to their

communities, through paid employment or

voluntary work if they so choose, and to be

engaged in the political process.

Many older people would like to continue

working and some, in fact, do so. In addition,

older people participating in the

WHO project expressed a desire and a

willingness to work as a volunteer in their

communities. Older people in most cities

have access to employment and volunteer

opportunities and in general feel respected

for their contributions. Older people would

like to have more opportunities for employment,

and would like to see current

employment and volunteer opportunities

better tailored to their needs and interests.

Th ey would also like to see more eff orts

made to encourage civic participation and

feel there are barriers to participation,

including physical barriers and cultural

stigmatization, surrounding participation

by older people.

Older person, Halifax

In many of the participating cities, older

people are very actively involved in voluntary

activities and enjoy many benefi ts

from volunteering, including a sense of self

worth, of feeling active, and of maintaining

their health and social connections.

Participants in some cities report that there

is a well-developed volunteer infrastructure,

such as volunteer resource centres or

well-established voluntary organizations. In

most cities, participants say there are many

opportunities to volunteer.

In Ponce, older people like feeling useful

through volunteering, and in Udine it is

noted that voluntary work is rewarding and

prevents isolation. Older people in Geneva

volunteer within clubs and organizations.

PAGE 52

Despite the importance of volunteering,

participants note many barriers for older

people, such as fi nding out about volunteer

opportunities, particularly those that

would be most suited to them. Participants

want more opportunities and a greater

range of options. Creating central registers

is suggested as a way to address this. In

Melbourne, there is a project under way

to use the Internet to match volunteers to

opportunities, and a site that lists volunteer

opportunities exists in Portland. Older

residents in Melville and Udaipur suggest

creating a central database or register of

volunteers, and participants in New Delhi

suggest this could be run by an organization

such as HelpAge India. .

In addition, older people face problems getting

to and from voluntary jobs, and some

report physical limitations in completing

the tasks assigned to them. In more developed

countries, some older people and service

providers report that un-reimbursed

expenses (such as for petrol) or liability

issues (on the part of the voluntary organizations)

impede their ability or willingness

to volunteer.

Several participants mention a general

decline or change in the voluntary sector

that aff ects older volunteers. Th is includes

a feeling that the ethic of volunteering is

diminishing and that younger people are

failing to replace older people. In Halifax,

an older person considers that increasing

paperwork and insurance costs are contributing

to the decline in the body of volunteers.

In Dundalk, it is suggested that insurance

costs be waived for older volunteers.

Suggestions for improving volunteering

call for strengthening voluntary organizations

generally, establishing elderly volunteer

corps, and reimbursing volunteers for

expenses related to their work. Participants

in Islamabad call for establishing a volunteer

corps of older people to work with the

disadvantaged. In Mayaguez, incentives for

older volunteers are suggested, and a service

provider in Mexico City recommends

that volunteers should be reimbursed for

their expenses. In Himeji, fi nancial support

for voluntary organizations is suggested.

In Shanghai, it is felt that a rewarding

and supportive social atmosphere would

encourage more people to volunteer. In

Tokyo, invitations are suggested as a way to

encourage older people to volunteer.

PAGE 53

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Caregiver, Jamaica

Service provider, Tripoli

Participants in many cities report that they

are eager and willing to work and have

the experience and qualifi cations to work.

However, older people face a variety of barriers

in fi nding work or staying employed.

Policies that make retirement mandatory by

a certain arbitrary age, which varies among

countries, are rejected by focus group

participants. Some countries have policies

whereby any money earned after the “retirement”

age is deducted from government

income support programmes or pensions,

thus creating another barrier for older

people who want to continue working.

In several places, older people report that

they are simply too frail to work, have

diffi culty getting to and from work, or do

not feel safe travelling to or while at work.

Several cities note that the only job opportunities

available to older people are often

menial, low-paid or generally undesirable.

In some areas, older people assist their

families by caring for grandchildren, and in

Mexico City it is felt that doing this kind of

work prevents older people from obtaining

proper employment.

In places of low income and limited government

support, some older people feel that

they need to work whether they want to or

not. In some cities (e.g. Moscow, Nairobi

and Ponce), focus group participants comment

that the general level of unemployment

and competition for jobs aff ect their

ability to fi nd work.

Older person, Istanbul

Despite these barriers, older people are still

working in a number of cities. Older people

in Tripoli note many benefi ts of continuing

to work, including income, combating

attitudes that older people are dependent,

and continued social connections. Many

older people in Himeji are willing to work,

and would like to see more opportunities

for employment. Older people in Amman

suggest that the time and experience of

older people should be used as long as they

are able to work, and that incentives be

provided to encourage participation.

PAGE 54

A few places, largely in developed countries,

do have policies, and some mention

specifi c companies that promote and value

older workers. In Mayaguez, service providers

note that there is little absenteeism

among older workers, and they also tend to

be punctual. In Melville, it is felt that workplaces

are changing and that there is a more

positive attitude to retaining older workers.

Participants have a number of suggestions

for how to improve and create new

opportunities for employment for older

people. Th ese include off ering incentives

to employers who hire older people, having

government-sponsored employment programmes,

creating public/private partnerships,

and hiring older people to do public

sector jobs.

Eliminating mandatory retirement, or age

restrictions for employment, is suggested

in the places where such legislation exists.

Allowing people to work beyond the

retirement age is suggested in Dundalk, and

eliminating the legal age restriction for employment

is proposed in Islamabad. Service

providers in Sherbrooke feel there should

be greater fl exibility in legislation and policies

to enable retired people to return to

work. One older person in Istanbul suggests

banning early retirement.

Th ere were also a number of suggestions

for improving the type or conditions of

work. In some places, respondents feel that

the problem was not having the information

and tools to match the skills and needs

of older workers with those of employers.

Suggestions to remedy the situation include

better advertising of positions, creating

databases to match older worker with jobs,

and developing a register listing older people’s

skills for potential employers to consult.

In Istanbul, it is felt there should be

more support for women working at home,

and in New Delhi, sensitizing employers to

the needs of older people is suggested.

Older person, Portland

Flexibility in opportunities for older people

in paid and voluntary work is cited as a way

to better tailor such opportunities to older

people.

Th ere are reports of rigid schedules, and a

feeling that voluntary jobs have become too

professionalized. Participants propose that

opportunities for paid and voluntary work

should be structured in ways that accommodate

older workers. Volunteering should be

more fl exible and better suited to the needs

of older people. At several places, there is a

mention of more fl exibility from employers

in terms of hours and seasonal or temporary

employment, and adjustment according to

the physical demands of the job.

PAGE 55

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Older people in Geneva feel that voluntary

opportunities should be fl exible and match

the ability of those volunteering, taking

into account the needs of older people who

may tire more quickly. Service providers

in Himeji feel that corporations should develop

an environment whereby older people

can work without diffi culty, and many corporations

have this as a goal for the future.

Lighter workloads and more fl exible sick

leave for older employees are suggested in

Halifax. Participants in London suggest

small projects that are interesting to older

people and that make use of their skills. In

Nairobi, Ponce and Tuymazy, participants

call for part-time opportunities. In Tokyo,

there is a human resource service for

temporary work, which may suit the needs

of older people. Older people in Tuymazy

consider that consulting work is particularly

suited to older people.

Reports about the level of civic engagement

vary. In general, older people are interested

in and willing to participate in civic functions.

In some places, elders already have an

active voice through community boards or

seniors’ boards. Some cultures reportedly

value the experience and expertise of seniors

and routinely put them in positions of

authority, though some felt these positions

were largely symbolic. In Melville, there

are special-interest groups in which older

people participate, and in Mayaguez, there

is a high proportion of elders in the city legislature.

Participants in Tripoli report that

older people serve on boards of trustees,

and in Halifax, older people are involved in

helping with elections.

Despite these reports of civic engagement,

a signifi cant proportion of cities also

report that opportunities for older people

to engage in civic aff airs are limited. Some

cities mention logistical barriers, such as

lack of transportation to civic functions,

lack of physical accommodation, and safety

concerns at large civic events.

Suggestions for improving civic engagement

include reserving seats for older people,

improving accessibility at civic events

(e.g. physical accessibility and providing

aids for the hard of hearing) and developing

or reinstating community boards and

other participatory bodies. Participants in

Dundalk consider that better information

about civic activities would lead to more

participation. In Portland, it is suggested

that older people become involved by voicing

their concerns to government offi cials.

Older people in La Plata call for more

opportunities for political participation by

older people, and a role for older people in

solving the problems of the community. In

Tokyo, it is suggested that older people be

allocated the specifi c civic role of taking

care of the concerns of other older people,

and participants in Saanich suggest that

older people be engaged in planning for

older people.

PAGE 56

Service provider, London

Training is seen as a way to enable older

people to connect with the workforce and

to participate as volunteers. Some cities report

that elders feel they lack the job skills

(largely surrounding the use of technology)

needed to compete in the workplace. A few

cities report that older people would like

opportunities for training or retraining (although

this is a suggestion more commonly

made by service providers than the elderly

themselves). In New Delhi, pre-retirement

training and retraining is suggested. In

Amman, training older people for light jobs

that can provide some pay is called for. In

Tuymazy, it is felt that training for older

workers should focus on self-employment

and small business opportunities.

Some participants suggest creating entrepreneurial

opportunities for older people as a

way for them to earn money and participate

in the workforce. Financing or otherwise

supporting self-employment opportunities

are suggested as ways of helping to support

older people, and such ideas tend to

come from cities that also report general

unemployment or low-income support for

older people (e.g. Cancún, Mexico City, New

Delhi, Ponce, Tripoli, Tuymazy and Udine).

Older people in several cities are actively

involved in a variety of self-employed activities,

such as handicrafts and gardening.

In San José, older people fi nd opportunities

as street vendors. Th ere are opportunities

for selling hand-made crafts in Cancún,

although older people there suggest that

having a location for a market would assist

them. In Tripoli, it is suggested that nongovernmental

organizations could assist

older people with small and home-based

businesses, and that farming could be

encouraged as an option for older people,

while in Tuymazy, farmers’ markets are

proposed as a way for older people to generate

income.

PAGE 57

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Reports of age discrimination in the workforce

are widespread. Th is is manifested in

a variety of ways, ranging from feelings of

disrespect by other workers to a fl at refusal

by employers to hire older workers. In some

cities it is apparently culturally unacceptable

for older people to work after the

retirement age. Some of these prejudices

come from the older people themselves;

some report that they simply do not want to

work after having worked all their lives

Th ere are reports of older people being

treated disrespectfully. Others mention

that it is diffi cult to work for people

younger than themselves, to take positions

that they consider to be beneath them, or to

work in environments where they feel they

are being patronized.

Th e degree to which older volunteers feel

their contributions are appreciated and recognized

also varies. Certifi cates of appreciation

are given out in Geneva. In Nairobi,

service providers feel that older people are

seen as leaders because of their experience

and trustworthiness.

In Udine, it is considered that there should

be more appreciation for the experience of

elders. Some suggest sensitivity training for

employers about the needs and qualifi cation

of older workers. In Mexico City, it is

felt that societal recognition of the value

of older peoples’ expertise and presence in

the workforce should be increased. Older

people in Jamaica suggest employing older

people to teach younger people about the

culture of aging, addressing both participation

and ageism.

PAGE 58

• Th ere is a range of options for older volunteers

to participate.

• Voluntary organizations are well-developed,

with infrastructure, training programmes

and a workforce of volunteers.

• Th e skills and interests of volunteers are

matched to positions (e.g. register or

database).

• Volunteers are supported in their voluntary

work, for example by being provided

with transportation or having the cost of

parking reimbursed.

• Th ere is a range of opportunities for older

people to work.

• Policy and legislation prevent discrimination

on the basis of age.

• Retirement is a choice, not mandatory.

• There are flexible opportunities, with

options for part-time or seasonal employment

for older people.

• Th ere are employment programmes and

agencies for older workers.

• Employee organizations (e.g. trade

unions) support fl exible options, such as

part-time and voluntary work, to enable

more participation by older workers.

• Employers are encouraged to employ and

retain older workers.

• Training in post-retirement opportunities

is provided for older workers.

• Retraining opportunities, such as training

in new technologies, is available to

older workers.

• Voluntary organizations provide training

for their positions.

• Opportunities for voluntary or paid work

are known and promoted.

• Transportation to work is available.

• Workplaces are adapted to meet the

needs of disabled people.

• Th ere is no cost to the worker of participating

in paid or voluntary work.

• Th ere is support for organizations (e.g.

funding or reduced insurance costs) to

recruit, train and retain older volunteers.

PAGE 59

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

• Advisory councils, boards of organizations,

etc. include older people.

• Support exists to enable older people to

participate in meetings and civic events,

such as reserved seating, support for

people with disabilities, aids for the hard

of hearing, and transportation.

• Policies, programmes and plans for older

people include contributions from older

people.

• Older people are encouraged to participate.

• Older people are respected and acknowledged

for their contributions.

• Employers and organizations are sensitive

to the needs of older workers.

• Th e benefi ts of employing older workers

are promoted among employers.

• Th ere is support for older entrepreneurs

and opportunities for self-employment

(e.g. markets to sell farm produce and

crafts, small business training, and micro-

fi nancing for older workers).

• Information designed to support small

and home-based business is in a formats

suitable for older workers.

• Older workers are fairly remunerated for

their work.

• Volunteers are reimbursed for expenses

they incur while working.

• Older workers’ earnings are not deducted

from pensions and other forms of income

support to which they are entitled.

PAGE 60

Part 11. Communication and information

Focus group participants strongly agree

that staying connected with events and

people and getting timely, practical information

to manage life and meet personal

needs is vital for active ageing. Participants

in most cities in the developed world say

there is a variety of information from many

diff erent general and specialized media

for older people, while in cities in developing

countries, people in the focus groups

emphasize a few community-wide media,

mostly television, radio and newspapers.

Yet the fear of missing information and

of being left out of the mainstream is

voiced almost everywhere. Rapidly evolving

information and communication

technologies are both welcomed as useful

tools and criticized as instruments of

social exclusion. Regardless of the variety of

communication choices and the volume of

information available, the central concern

expressed in the focus groups is to have

relevant information that is readily accessible

to older people with varying capacities

and resources.

Older person, Halifax

In all cities, local community-wide media are

singled out as providers of useful information.

In developing countries and in the Russian

Federation, the communication media familiar

to older people tend to be limited to radio,

television and newspapers. In developed

countries, an abundance of general and targeted

information of interest to older people

is described, from diverse sources including

the Internet. Valued everywhere is information

that reaches older people in their daily

lives and activities, through direct personal

delivery, telephone and distribution in key

locations: community centres and bulletin

boards, public services, libraries, stores, doctors’

offi ces and health clinics. Older people in

Istanbul report that the telephone is the most

universal and reliable way of communicating

with them. Governments and voluntary

organizations are seen to have a major role

in ensuring that information is widely available:

systematic, eff ective public distribution

services are valued as an age-friendly feature.

In Himeji, there is said to be a well-structured

distribution of municipal information to residents’

associations, who pass it on to district

leaders who then deliver it to every household.

In cities where the private sector has yet

to become aware of this growing grey market,

such as Tripoli, business too is mentioned as

a potential funder of information dissemination

for older people. Distributing a local

directory of “age-friendly” services, suggested

by older people in Saanich, could appeal to a

chamber of commerce, for example.

PAGE 61

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Aff ordable access to communication channels

and information is essential. Radio is

the mainstay of communication for older

people in Nairobi because it is cheap; in

Udaipur, local notice boards are important

in reaching people from lower socioeconomic

groups. To ensure information access

in Tuymazy, free newspaper subscriptions

are provided to retirees by former

employers. In Dundalk, the cost of a home

telephone line is publicly subsidized for

people over the age of 70. Free publications

and public access to newspapers, computers

and the Internet in community centres and

libraries, at no or minimal cost, are agefriendly

features in other cities..

Caregiver, Moscow

Regardless of the number and variety of information

sources, the preoccupation with

getting relevant and timely information is

shared in cities at varying stages of development.

In some developed cities, such as

Geneva, managing the information overload

is diffi cult and important information

may be missed. A frequent barrier is lack of

awareness of available information or services,

or not knowing how to locate needed

information. Th e result is that older people

may not receive benefi ts or services to

which they are entitled or learn about them

too late to apply. Knowing how to deal with

intrusive telemarketing and identify frauds

and scams is another concern, voiced in a

few developed cities only. Older city dwellers

in developing countries more often

face the problem of insuffi cient up-to-date

information on important matters, such as

health, legal rights, benefi t entitlements,

services and community events. It is noted

in La Plata that the general community media

do not cover topics important for older

people in enough detail to be useful.

A frequent suggestion for making communication

more age-friendly is to provide

more information targeted to older people

through dedicated newspapers or regular

columns in the general press, as well as

through specialized radio and television

programmes. Another idea is to have communication

channels broaden their programming

and coverage of issues to include

the interests of an older adult audience.

Older people in some cities complain that

television in particular seems to exclude

their interests and tastes.

People want information to be coordinated

in one easy-to-access service that is widely

known throughout the community. In

Portland, the local county has a live 24-

hour telephone information service. Older

people consulted in New Delhi suggest that

a central and respected voluntary organization,

such as HelpAge India, collect and

organize a database of information relevant

to older people and make it available by

telephone. In Islamabad, a community

information room with newspapers and

television is recommended.

PAGE 62

Service provider, Mayaguez

No matter how developed the city, word of

mouth is the principal and preferred means

of communication for older people, both

through informal contacts with family and

friends and through clubs, associations,

public meetings, community centres and

places of worship. Radio is a very popular

information source in many cities, with

broadcasting in vernacular languages or

with open-line programmes whereby callers

ask questions to experts or participate

in on-line discussions. Th e interpersonal

dimension of communication is very important,

and it is repeated that staying active

and involved in the community is the best

way to remain informed. Regret is expressed

about losing opportunities to interact with

others as a result of changes, such as new

high-rise buildings in the neighbourhood,

the closing of community post offi ces, and

automating banking and other services. Oral

communication is especially important for

older people who are visually impaired and

for those who are not literate. Illiteracy rates

are very high in the older adult population

in developing countries, and in developed

countries, older people on average have a

lower level of literacy than younger people.

Th e “grapevine” works too because people

trust the person providing the information

and because they can ask questions until

they get what they want to know. Receiving

the attention of a real person who is helpful,

clear and unhurried is highly valued by older

people around the world.

Older person, Tripoli

Age-friendly communication everywhere

recognizes and uses these informal channels

to reach older people. One way is to

regularly provide relevant information in

places where older people normally gather;

another is to create social occasions to off er

information of interest to them. In Rio de

Janeiro, for instance, it is proposed using

the auditorium of the health care centre for

educational lectures. A third strategy is to

inform individuals who will in turn pass

on the information to others, one-to-one.

Th ese “key informants” can be volunteers,

as suggested in Jamaica, social and health

service providers or people in service

industries – estate agents, hairdressers,

postal workers, or the doormen in apartment

buildings in Rio de Janeiro who know

each resident and are a recognized source

of informal information and support.

Th e problem of reaching those who are

socially isolated – older people who are out

of touch with the world because they live

alone with signifi cant impairments and

have minimal family support – arises in

richer and poorer cities alike. E-mail and

63

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

tioned, but rarely. One-to-one outreach by

trusted individuals is the favoured approach,

through volunteers who visit or

telephone or through social service workers.

Anticipating the locations outside the

home where older people at risk of social

isolation may be found is also suggested:

the use of the district health clinic as a

distribution point for information about

services for older people with health problems

is suggested in San José.

Older person, London

Th e single biggest universal barrier to communicating

with older people is the visual

and auditory presentation of information.

Font size on text materials, mainly hard

copy but also visual displays such as television,

is too small to read. Product labels and

instructions, particularly for medications,

are hard to decipher. Page layout is often

confusing, with too much information in a

small space. Auditory information is spoken

too quickly and commercials on radio

and television make older people lose their

train of thought. Th e language used is often

too complicated, with many unfamiliar

terms. Offi cial forms – which are vital for

receiving services and benefi ts – are especially

diffi cult to understand.

Service provider, Mexico City

Service automation adds a further layer of

complexity to daily transactions. Visual

displays and buttons on mobile telephones

and electronic equipment are too small,

while automated banking, postal, parking

and other ticket machines are all diff erent,

are poorly lit and have unclear instructions.

For people in a wheelchair, the panels are

too high to reach. To make telephones accessible

to illiterate older people so they can

call family or services, a suggestion made

in Amman, is to colour-code the telephone

buttons and the telephone numbers.

Automated answering services are a general

source of complaint: there is too much

information given too quickly, the choices

are confusing, and there is often no opportunity

to speak to a live person.

Information technology, especially computers

and the Internet, is appreciated by some

older people for its comprehensiveness and

convenience. In Tripoli, older people say

the Internet is a good way for them to stay

in touch with children who live far away,

perhaps in other countries.

Nevertheless, many older people experience

a sense of exclusion because they do not use

computers and the Internet. Th e conversion

of direct services and documentation

to computer technology increases feelings

of exclusion. In developing countries and

PAGE 64

the Russian Federation, computers are too

costly for many older people or just not

widely available in the community. In other

places, physical access to computers is possible

but older people are totally unfamiliar

with the technology and are afraid they

cannot learn. Aff ordable public access to

computers for older people in community

centres, older people’s clubs, public services

and libraries is an important age-friendly

feature. Computer training, preferably

adapted to individual needs and pace of

learning and given by a trusted person, is

strongly advised. In Halifax, for example,

older people mention a permanent Internet

tutor who is available to help out older

people individually, visiting them in their

homes if requested.

Like other citizens, older people have a

personal responsibility to keep abreast of

new information by staying involved in

community activities, and to make an effort

to adapt to change and take the risk to

learn. Collectively, governments, voluntary

organizations and the private sector are

responsible for removing the communication

barriers that progressively cut older

people off from others, particularly barriers

related to poverty, low literacy and diminished

capacity.

• A basic, universal communications system

of written and broadcast media and

telephone reaches every resident.

• Regular and reliable distribution of

information is assured by government or

voluntary organizations.

• Information is disseminated to reach

older people close to their homes and

where they conduct their usual activities

of daily life.

• Information dissemination is coordinated

in an accessible community service that

is well-publicized – a “one-stop” information

centre.

• Regular information and programme

broadcasts of interest to older people

are off ered in both regular and targeted

media.

• Oral communication accessible to

older people is preferred, for instance

through public meetings, community

PAGE 65

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

centres, clubs and the broadcast media,

and through individuals responsible for

spreading the word one-to-one.

• People at risk of social isolation get

information from trusted individuals

with whom they may interact, such as

volunteer callers and visitors, home support

workers, hairdressers, doormen or

caretakers.

• Individuals in public offi ces and businesses

provide friendly, person-to-person

service on request.

• Printed information – including offi cial

forms, television captions and text on visual

displays – has large lettering and the

main ideas are shown by clear headings

and bold-face type.

• Print and spoken communication uses

simple, familiar words in short, straightforward

sentences.

• Telephone answering services give

instructions slowly and clearly and tell

callers how to repeat the message at any

time.

• Users have the choice of speaking to a

real person or of leaving a message for

someone to call back.

• Electronic equipment, such as mobile

telephones, radios, televisions, and bank

and ticket machines, has large buttons

and big lettering.

• Th e display panel of bank, postal and

other service machines is well-illuminated

and can be reached by people of

diff erent heights.

• Th ere is wide public access to computers

and the Internet, at no or minimal

charge, in public places such as government

offi ces, community centres and

libraries.

• Tailored instructions and individual assistance

for users are readily available.

PAGE 66

Health and support services are vital to

maintaining health and independence in

the community. Many of the concerns

raised by older people, caregivers and

service providers in the focus groups deal

with the availability of suffi cient good

quality, appropriate and accessible care.

Participants in the WHO consultation

report their experiences from the context

of very diff erent systems with very diff erent

expectations; but nevertheless older people

everywhere voice a clear desire for basic

health and income support. Health care

costs are perceived as too high everywhere,

and the desire for aff ordable care is consistently

expressed.

Older person, Portland

In many cities in developing countries, a

basic shortage of necessary services and

supplies is observed, and in others, services

are found to be poorly distributed. Some of

the most developed countries have, at the

same time, the greatest volume and range

of health and community support services

and the greatest number of complaints.

While this certainly refl ects dissatisfaction

with existing services, it also shows that

older people in these cities have a level of

access to services that may be lacking in

other parts of the world.

In most collaborating cities, the supply,

organization and fi nancing of many health

and social services are decided by the state

or national government rather than the city.

Also, the supply and professional training

of health and social workers are outside

the city’s control. Nevertheless, health and

social services are delivered within a city

by local people in local establishments, and

community-based for-profi t and voluntary

groups play an important role in delivering

support and care. Public decision-makers

and the private and voluntary sectors at the

city level do have an infl uence on the number,

range and location of services and on

other aspects of the accessibility of facilities

and services in their territory. Local service

authorities also provide staff training and

set service performance standards. Civil

society plays a role in providing fi nancial

support and voluntary work. In reporting

the fi ndings and developing a checklist of

community and health service features in

an age-friendly city, the Guide focuses on

those aspects of community support and

health services that are within the scope of

an age-friendly city’s infl uence.

Part 12. Community support and health

services

PAGE 67

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Health service issues dominate the focus

group discussions in the majority of cities,

refl ecting their importance for active

ageing. Access to health care as well as to a

range of health services that are not strictly

medical are major themes. Although less

attention is paid in general to community

support and social services, the key

attributes of an age-friendly city can be

identifi ed from the comments made by the

participants.

Having well-located, easily accessible health

services is fundamentally important for

older people in every collaborating city.

Older people in cities such as Amman, Rio

de Janeiro, Sherbrooke and Tokyo value

having health services near by, and in

Geneva and Shanghai, older people appreciate

good transportation to health facilities.

Services that are far away or diffi cult

to reach are often seen as barriers. Public

transportation is considered inadequate in

some places and in others, such as Delhi

and Mexico City, transportation for people

with disabilities is reported to be a particular

problem. Access to health care in

emergency situations is a frequent concern.

Besides particular complaints, such as a

lack of emergency care in some cities, those

consulted also mention that ambulance

services are either insuffi cient (Ponce) or

too slow because of heavy traffi c (Moscow).

Ways to minimize geographical barriers

include the idea of co-locating or decentralizing

services so they are available in all

neighbourhoods. Other ideas are to off er

transportation by volunteers and to provide

health emergency telephone services, as in

Himeji, for older people living alone.

Barrier-free structures and mobility within

health facilities is important, as is the safety

of the buildings. Among the barriers noted

are poorly maintained elevators and ramps

in Udaipur, poor building access for people

with disabilities and a lack of wheelchairs

or walking frames for patients in Cancún,

and overcrowded facilities in many other

cities. Safety concerns or lack of space in

nursing homes are raised in Amman, La

Plata and Portage la Prairie.

Another frequently mentioned barrier to

accessing care is insuffi cient knowledge

about the health services available in the

city. As observed in Melbourne, if services

are not known about they are not used.

Better advertising of local health services,

educating older people on the health

system, coordination of information, and

health information telephone services are

suggested as possible solutions.

Finally, the attitudes of health service providers

towards older people are frequently

mentioned. Tuymazy is one of the few

places reporting the polite and friendly behaviour

of clinic receptionists and nurses.

Negative attitudes and poor communication

by health providers are common complaints

about care. Problems voiced include

indiff erence, disrespect, uncaring attitudes,

and treating older people as a burden or

as a drain on resources. General suggestions

off ered for improving the attitudes

and behaviour of service providers are to

improve their communication skills and

to train health professionals to treat older

people better. In Amman, it is suggested

that young people be encouraged to do voluntary

work caring for older people.

PAGE 68

Older person, London

In all cities, people’s views refl ect the need

for a wide range of health services for older

people. Th e availability of various specifi c

forms of care for older people emerges

either as an asset or as a gap in the urban

landscape: geriatric clinic services and

hospital beds, adult day centres, care for the

demented, mental health services, respite

care and training for caregivers, rehabilitation

and palliative care are mentioned.

Along with services, a greater supply of

equipment is recommended, such as wheelchairs,

walking frames and hearing aids.

However, the health services that receive

the most attention worldwide are disease

prevention and health promotion, home

care, and nursing (long-term care) homes.

Older people and others in several cities

either report a lack of services or programmes

for disease prevention and health

promotion or include them in their suggestions

for improvement. In the list of important

services are preventive screening,

physical activity, education on injury prevention,

nutritional guidance, and mental

health counselling. Age-friendly features

reported in the Ruhr metropolitan area

include self-help groups or organizations

off ering sports activities for fi tness and

rehabilitation, and regular health checks

at home. Older people in Mexico City are

pleased with the targeted vaccination campaign

and free eyeglasses. Participants in

Saanich suggest expanding seniors’ centres

into community wellness centres, and

people in Tuymazy propose providing older

people with subsidized access to health resorts

(spas). In Islamabad and Mexico City,

it is seen as a good idea to provide services

in the local neighbourhoods rather that at a

central point.

One very consistent theme is the need for

a wide range of home support and care

services – from help with shopping and/or

providing meals to home visits from doctors

and other service providers. With few

exceptions, the focus group participants

want services that would allow them to tend

to their health and personal care needs in

their own homes. Barriers experienced in

getting home care services include a general

lack of such services, poor organization

of services, restrictive eligibility criteria,

high cost, and high turnover in home care

staff . Suggestions for improving home care

services depend very much on the context.

In several cities, especially in developing

countries, the message is simply “provide

home care”. In other cities, comments focus

on how to improve the number or range of

services (e.g. physiotherapy and psychological

counselling) or their quality (e.g. providing

care soon after discharge from hospital,

increasing the number of case managers,

and always being cared for by the same

person). In some places, comments deal with

ways of managing costs, such as through

insurance coverage or by using the services

of a housekeeping cooperative enterprise,

PAGE 69

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

as mentioned in Sherbrooke. In Shanghai,

caregivers report that people over 80 years

of age, the widowed, people on a low income

and the disabled are entitled to one hour per

day of free housekeeping.

A common concern is the lack of adequate

and aff ordable options in the city to care

for older people no longer able to live in

their own homes. Lack of vacancies and

high cost are the most frequent complaints.

Caregivers in Portage la Prairie observe

that there is insuffi cient storage space for

personal eff ects in nursing homes, and

older people in Geneva suggest that nursing

homes be located in the centre of the city

or have easy access to the centre. Serious

concerns are expressed in a few cities about

safety, substandard care in homes for poor

older people, insuffi cient personnel, and

suspected general sedation of residents.

Ideas for alternative models are proposed:

caregivers in Amman suggest establishing

small homes housing a few residents instead

of the “huge” nursing homes; service

providers in Jamaica and older people in

Udine similarly call for such group homes

off ering housekeeping and some health and

personal care.

Th e scope of community social services and

the way in which they are provided vary

enormously among cities. In some cities,

particularly in developed countries, social

services are delivered, or funded, by the

government. Elsewhere, support services

are reported to be provided primarily by

families, religious institutions, charitable

organizations or community groups.

Among the appreciated services off ered by

the community are cheaper meals for older

people in restaurants in Rio de Janeiro

and Geneva, help with pensions and other

entitlements in Jamaica, and a system for

screening contractors and handyman services

in Portland to ensure they are legitimate.

Community centres and centres for

older people are regarded as ideal locations

for social services because of their convenience,

familiarity and accessibility.

Several barriers are noted, with more

frequent and more acute problems in less

developed regions: services are insuffi cient,

too costly, diffi cult to access or of poor

quality. As with health services, some participants

say that they simply do not have

good information about what is available

or how to access it. Lack of coordination

among services, causing needlessly complicated

application formalities and gaps in

services, is also frequently raised as a problem.

Suggestions for improving community

social services are varied. Improving

coordination among services, adding more

case managers and integrating service

teams are ideas proposed in cities with

well-developed but somewhat fragmented

service networks. Reducing or facilitating

administrative formalities are mentioned in

the majority of cities, regardless of region.

Co-locating social and health services in

community or older people’s centres and

providing more funding for services are

other recommendations.

PAGE 70

Many social services are said to be needed

or improved, often to protect and care for

older people with low incomes who constitute

the majority in many cities. In addition

to enhancing basic income support, older

people think their cities should establish

or strengthen: shelter and protection for

homeless and destitute older people and

people who have been abused; meals services

and programmes; discounts on utilities

for people with low incomes; registers

of older people living alone; assistance in

obtaining pensions and other entitlements;

and spiritual support. A good example

described in Mexico City is an ID card for

older people, giving the holder access to

lower prices and some free services.

A consistent theme is the need for volunteers

to help fi ll gaps in the health and

social services. More volunteers are wanted

to assist older people in clinics and hospitals,

as well as to deliver social services and

home care, to provide transportation for

shopping and appointments, or simply to

walk the pets of older people who are no

longer able to do so themselves. Suggested

sources of voluntary help are the “50+”

associations of young retirees, students in

social and health services, and schoolchildren.

Intergenerational volunteering is an

idea repeated in several cities. Strong voluntary

networks are easier to mobilize in

established communities where people feel

socially connected: a barrier mentioned in

Islamabad is that the city is relatively new

and people do not know each other well.

Older person, Rio de Janeiro

Two other concerns are raised in a few cities:

taking account of older people in emergency

situations and the lack of cemetery

space. Although these issues are seldom

mentioned, they are nevertheless important

in expanding cities. Participants in two

locations perceive a gap in support for older

people in emergencies, such as natural

disasters and human confl icts. In Jamaica,

where hurricanes are frequent, older people

comment that churches play a vital role in

providing care during disasters. Service

providers in Amman suggest that the city

develop emergency and disaster plans that

include older people. Although it is not proposed

in this context, a useful suggestion

for emergencies made in Dundalk is to have

a community register of older people living

alone. Th e lack of suffi cient cemetery space

is mentioned very briefl y in Cancún and

Melbourne; as a solution, service providers

in the latter city suggest having a “vertical”

or layered cemetery.

PAGE 71

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

• Health and social services are well-distributed

throughout the city, are conveniently

co-located, and can be reached

readily by all means of transportation.

• Residential care facilities, such as retirement

homes and nursing homes, are

located close to services and residential

areas so that residents remain integrated

in the larger community.

• Service facilities are safely constructed

and are fully accessible for people with

disabilities.

• Clear and accessible information is provided

about the health and social services

for older people.

• Delivery of individual services is coordinated

and with a minimum of bureaucracy.

• Administrative and service personnel

treat older people with respect and sensitivity.

• Economic barriers impeding access to

health and community support services

are minimal.

• Th ere is adequate access to designated

burial sites.

• An adequate range of health and community

support services is off ered for

promoting, maintaining and restoring

health.

• Home care services are off ered that

include health services, personal care and

housekeeping.

• Health and social services off ered address

the needs and concerns of older people.

• Service professionals have appropriate

skills and training to communicate with

and eff ectively serve older people.

• Volunteers of all ages are encouraged and

supported to assist older people in a wide

range of health and community settings.

• Emergency planning includes older people,

taking into account their needs and

capacities in preparing for and responding

to emergencies.

PAGE 72

determinants of active ageing, more important

still are policies that reduce economic

inequalities in access to all the city’s structures,

services and opportunities.

Design for diversity has emerged as a prime

characteristic of an age-friendly city that

is repeated often across many topic areas.

Within the WHO life course perspective

for active ageing described in Part 2, design

for diversity is the key to supporting optimal

capacity among high-functioning individuals

and enabling older people to function

who would otherwise become dependent.

According to the project participants,

it should be normal in an age-friendly city

for the natural and built environment to

anticipate users with diff erent capacities

instead of designing for the mythical “average”

(i.e. young) person. An age-friendly

city emphasizes enablement rather than

disablement; it is friendly for all ages and

not just “elder-friendly”. Th ere should be

enough public seating and toilet facilities;

dropped curbs and ramps to buildings

should be standard features, and lights at

pedestrian crossings should be safely timed.

Building and housing design should be barrier-

free. Information materials and communication

technologies should be adapted

to suit diverse perceptual, intellectual and

cultural needs. In a word, spaces and structures

must be accessible.

Th e starting point for this Guide was the

concept that 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. Th e assets and barriers reported by

approximately 1500 older people and 750

caregivers and service providers consulted

in this global project confi rm this idea and

provide many examples to show how the

features of city refl ect the determinants of

active ageing in many interconnected ways.

Th e city’s landscape, buildings, transportation

system and housing contribute to

confi dent mobility, healthy behaviour,

social participation and self-determination

or, conversely, to fearful isolation, inactivity

and social exclusion. A wide range of

opportunities for age-integrated as well as

age-targeted social participation fosters

strong social connections and personal empowerment.

Empowerment and self-worth

are reinforced by a culture that recognizes,

respects and includes older people. Relevant

information in appropriate formats also

contributes to personal empowerment,

as well as to healthy types of behaviour.

Accessible and well-coordinated health

services have an obvious infl uence on older

people’s health status and health behaviour.

Although opportunities for paid work in

urban settings are related to the economic

Part 13. Wrapping up and moving

forward

PAGE 73

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Acknowledging and respecting diversity

should characterize social and service

relationships no less than physical structures

and materials. Th e participants in this

WHO project make it clear that respect and

consideration for the individual should be

major values on the street, at home and on

the road, in public and commercial services,

in employment and in care settings. In

an age-friendly city, users of public spaces

should be considerate in sharing the amenities,

and priority seating in public transport

and special needs stopping and parking

areas should be respected. Services should

employ friendly staff who take the time

to give personal assistance. Tradespeople

should serve older people as well and as

promptly as other clients. Employers and

agencies should off er fl exible conditions

and training to older workers and volunteers.

Communities should recognize older

people for their past contributions, not only

for their current ones. Because education

fosters awareness, schoolchildren should be

taught about ageing and older people and

the media should portray them in realistic

and non-stereotypical ways.

Th e life course approach includes all ages

within the process of promoting active

ageing. It also embraces the value of intergenerational

solidarity. In the view of

the project participants, another important

characteristic of an age-friendly city

is that it should foster solidarity between

generations and within communities. An

age-friendly city should facilitate social

relationships – in local services and in the

activities that bring together people of all

ages. Opportunities for neighbours to get

to know each other should be fostered; they

should watch out for each other’s safety

and help and inform each other. Th anks to

a network of trusted family, friends, neighbours

and service providers, older members

of the community should feel integrated

and safe. Moreover, there should be personalized

outreach to older people at risk of

being socially isolated, and the economic,

linguistic or cultural barriers experienced

by many older people should be minimized.

Th e strong connections among the diff erent

aspects of city living made by people

consulted in the WHO project clearly show

that an age-friendly city can only result

from an integrated approach centred on

how older people live. Taking this approach

means coordinating actions across diff erent

areas of city policy and services so that

they are mutually reinforcing. Based on the

reports of the older people and others in

the project, joint action that respects the

following relationships appears especially

important.

• Housing must be considered in connection

with outdoor spaces and the rest of

the built environment such that older

people’s homes are located in areas safe

from natural hazards and are close to

services, other age groups and civic attractions

that keep them integrated in the

community, mobile and fi t.

• Transportation services and infrastructures

must always be linked to opportunities

for social, civic and economic participation,

as well as to access to essential

health services.

PAGE 74

• Social inclusion of older people must

target social arenas and roles that carry

power and status in society, such as decision-

making in civic life, paid work and

media programming.

• Because knowledge is key to empowerment,

information about all aspects of

city living must be accessible to everyone

at all times.

Th is project is a starting point for many

more community development and research

activities, as well as for the establishment

of a larger global network of

age-friendly communities. Th e next steps

for collaborating cities and for WHO will

be to confi rm the validity of the checklists.

One city has already conducted site visits to

verify the barriers in the natural and built

environments and in services that were reported

by older people. Others are returning

to the original focus group participants

to determine whether the features in the

Guide accurately capture what they said,

or are setting up focus groups with older

people in other locations to assess the level

of agreement between their views and the

checklists. Another approach to validation

will involve experts in the fi eld of ageing,

who will compare the checklists based on

the views of older people with evidence

from gerontological research and practice.

At the same time, many other cities have

expressed an interest in using the WHO

Guide and checklists to initiate age-friendly

city development. Currently being considered

are country-level networks, for example

in Japan and Spain, as well as regional

“hubs” in the Middle East, in Canada and

in Latin America and the Caribbean. To

facilitate the spread of age-friendly cities,

translation of the Guide into several languages

is under way, including Chinese,

French, German, Japanese, Portuguese and

Spanish. Because the age-friendly cities idea

has much in common with the successful

and eff ective Healthy Cities concept, an

active and mutually benefi cial link between

the two networks is being pursued. Within

WHO, the Ageing and Life Course programme

will continue to provide an institutional

“home” for the WHO age-friendly

city initiative.

Focus group participants reported several

examples of age-friendly practices in their

cities. Some of these have been very briefl y

mentioned in this Guide. Another important

step will be to obtain further information

about these initiatives from the project

leaders and to publish an inventory of these

good practices. A conference to exchange

local and international age-friendly city initiatives

was held in June 2007 in the Ruhr

metropolitan area, sponsored by the State

Government of North Rhine Westphalia,

to mark the selection of the city of Essen

as a European Capital of Culture for 2010.

A further best practices meeting is being

planned for Istanbul, also in connection

with the selection of this city as the other

2010 European Capital of Culture. To generate

more good practices from the WHO

research, experts and service providers will

PAGE 75

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

be invited to identify interventions corresponding

to the age-friendly features in the

checklists. Th e current checklists also will

be tested in at least one location for their

usefulness in creating age-friendly interventions.

Th e research leading to the Guide has yielded

many rich fi ndings worldwide, as well as

connections among researchers concerned

with ageing and the environment. With

the support of the Institute of Aging of the

Canadian Institutes of Health Research,

collaboration among researchers is being

encouraged to advance knowledge about

ageing in urban settings. Technical research

papers are planned that will describe

more fully the concept and methodology

of the WHO-led research, more closely

examine age-friendly settings in relation

to active ageing, and reveal evidence of the

convergences between ageing, urbanization

and globalization – the major forces shaping

the 21st century that are central to this

project.

As stated earlier, the present research did

not focus specifi cally on the cross-cutting

active ageing determinants of gender

and culture, although their eff ects are

mentioned sporadically in this Guide. For

example, it is observed in many cities that

men are less engaged in social activities

than women, and the situation of many older

women is described in the barriers faced

by economically disadvantaged groups in

many areas of urban living. Further focused

research, involving collaboration among

cities in diff erent regions of the world, will

be conducted to address these specifi c determinants,

beginning with an initiative led

by the New York Academy of Medicine on

the theme of “ageing in a foreign land”.

Finally, non-urban communities must

also become more age-friendly. In many

countries, older people constitute a high

percentage of the population in rural and

remote areas as a consequence of the emigration

of younger people. Canadian federal

and provincial governments are leading a

project to identify the age-friendly community

features in several small towns and

villages, and the results will eventually be

shared worldwide.

Th ere is already much enthusiasm for disseminating

and adopting the Guide and

checklist. New initiatives and collaborators

in a worldwide network are welcome.

Active ageing in supportive, enabling cities

will serve as one of the most eff ective approaches

to maintaining quality of life and

prosperity in an increasingly older and

more urban world.

PAGE 76

References

Nations Department of Economic and Social

Aff airs, Population Division, 2006 (http://

www.un.org/esa/population/publications/

ageing/ageing2006.htm, accessed 10 July

2007).

2. Population issues: meeting development goals.

Population Fund, 2007 (www.unfpa.org/pds/

facts.htm, accessed 26 June 2007).

United Nations Population Fund, 2007 (www.

unfpa.org/pds/urbanization.htm, accessed 26

June, 2007).

4. World urbanization prospects: the 2005

United Nations Department of Economic

and Social Aff airs, Population Division, 2006

(www.un.org/esa/population/publications/

WUP2005/2005wup.htm, accessed 26 June

2007).

2005 (www.who.int/social_determinants/

resources/urban_settings.pdf, accessed 26

June 2007).

New York, United Nations Department of

Economic and Social Aff airs, Population

Division, 2006 (www.un.org/esa/population/

publications/WUP2005/2005wup.htm,

accessed 26 June 2007).

Nairobi, United Nations Human Settlements

Programme, 2006 (http://ww2.unhabitat.

org/programmes/housingpolicy/pubvul.asp,

accessed 26 June 2007).

1997, No. 4: 21.

Nations, 2002.

Health Organization, 2002 (http://whqlibdoc.

who.int/hq/2002/WHO_NMH_NPH_

02.8.pdf, accessed 26 June 2007).

Physicians of London, 2006.

12. Kalache A, Kickbusch I. A global strategy for

Nations, 2006 (http://www.un.org/esa/socdev/

ageing/documents/MIPAA/GuidelinesAgei

ngfi nal13%20Dec2006.pdf, accessed 26 June

2007).

Washington, DC, AARP Public Policy

Institute, 2005 (www.aarp.org/research/

housing-mobility/indliving/d18311_

communities.html, accessed 26 June 2007).

Service of New York, 2004 (http://www.vnsny.

org/advantage, accessed 26 June 2007).

United Nations Human Settlements

Programme, 1993 (www.unhabitat.org/list.

asp?typeid=15&catid=298&RecsPerPage=ALL,

accessed 26 June 2007).

(http://www.idgo.ac.uk/design_guidance/

index.htm, accessed 26 June 2007).

Ageing and Life Course

Family and Community Health

World Health Organization

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Switzerland

E-mail: activeageing@who.int

www.who.int/ageing/en

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