Global Age-Friendly Cities: a Guide

Global Age-friendly Cities: A Guide

For further information, please contact: ISBN 978 92 4 154730 7 Ageing and Life Course Family and Community Health World Health Organization Avenue Appia 20 CH-1211 Geneva 27 Switzerland E-mail: [email protected] www.who.int/ageing/en Fax: + 41 (0) 22 791 4839 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Global Age-friendly Cities: A Guide WHO Library Cataloguing-in-Publication Data 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)

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PAGE iI AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Table of Contents

Acknowledgements iv

Introduction: about this Guide 1

Part 1. Global ageing and urbanization: meeting the challenge of 3 humanity’s success

Part 2. Active ageing: a framework for age-friendly cities 5

Part 3. How the Guide was developed 7

Part 4. How to use the Guide 11

Part 5. Outdoor spaces and buildings 12

Part 6. Transportation 20

Part 7. Housing 30

Part 8. Social participation 38

Part 9. Respect and social inclusion 45

Part 10. Civic participation and employment 51

Part 11. Communication and information 60

Part 12. Community support and health services 66

Part 13. Wrapping up and moving forward 72

References 76

PAGE iII 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 warm- ly 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 La Plata, Argentina New Delhi, India San José, Costa Rica Cancún, Mexico London, United Ponce, Puerto Rico Shanghai, China Dundalk, Ireland Kingdom Portage la Prairie, Sherbrooke, Canada Geneva, Switzerland Mayaguez, Puerto Rico Canada Tokyo, Japan Halifax, Canada Melbourne, Australia Portland, Oregon, Tripoli, Lebanon Himeji, Japan Melville, Australia United States of America Tuymazy, Russian Islamabad, Pakistan Mexico City, Mexico Rio de Janeiro, Brazil Federation Istanbul, Turkey Moscow, Russian Ruhr metropolitan Udaipur, India Kingston and Montego Federation region, Germany Udine, Italy Bay (combined), Jamaica Nairobi, Kenya Saanich, Canada

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 iV AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Introduction: about this Guide

Population ageing and urbanization are and barriers they experience in eight areas two global trends that together comprise of city living. In most cities, the reports major forces shaping the 21st century. At from older people were complemented by the same time as cities are growing, their evidence from focus groups of caregivers share of residents aged 60 years and more is and service providers in the public, volun- increasing. Older people are a resource for tary and private sectors. Th e results from their families, communities and economies the focus groups led to the development of in supportive and enabling living environ- a set of age-friendly city checklists. ments. WHO regards active ageing as a life- • Part 1 describes the converging trends long process shaped by several factors that, of rapid growth of the population over alone and acting together, favour health, 60 years of age and of urbanization, and participation and security in older adult outlines the challenge facing cities. life. Informed by WHO’s approach to active ageing, the purpose of this Guide is to • Part 2 presents the “active ageing” con- engage cities to become more age-friendly cept as a model to guide the development so as to tap the potential that older people of age-friendly cities. represent for humanity. • Part 3 summarizes the research process An age-friendly city encourages active age- that led to identifying the core features of ing by optimizing opportunities for health, an age-friendly city. participation and security in order to en- • Part 4 describes how the Guide should be hance quality of life as people age. used by individuals and groups to stimu- late action in their own cities. In practical terms, an age-friendly city adapts its structures and services to be • Parts 5–12 highlight the issues and con- accessible to and inclusive of older people cerns voiced by older people and those with varying needs and capacities. who serve older people in each of eight areas of urban living: outdoor spaces and To understand the characteristics of an buildings; transportation; housing; social age-friendly city, it is essential to go to participation; respect and social inclu- the source – older city dwellers. By work- sion; civic participation and employment; ing with groups in 33 cities in all WHO communication and information; and regions, WHO has asked older people in community support and health services. focus groups to describe the advantages 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 1 • Part 13 integrates the ﬁ ndings within undertaking initiatives to translate the the WHO active ageing perspective and research into local action, to expand the highlights strong connections between the scope beyond cities, and to spread it to age-friendly city topics. Th ese reveal the more communities. An age-friendly com- principal traits of the “ideal” age-friendly munity movement is growing for which city and show how changing one aspect this Guide is the starting point. 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

PAGE 2 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 that is, cities with 10 million inhabitants or people aged 60 and over as a proportion of more, increased tenfold from 2 to 20 during the global population will double from 11% the 20th century, accounting for 9% of the in 2006 to 22% by 2050. By then, there will world’s urban population by 2005 (4). Th e be more older people than children (aged number and proportion of urban dwellers 0–14 years) in the population for the fi rst will continue to rise over the coming de- time in human history (1). Developing coun- cades, and particularly in cities with fewer tries are ageing at a much faster rate than than fi ve million inhabitants (5). Again, this developed countries: within fi ve decades, growth is happening much more rapidly in just over 80% of the world’s older people will developing regions. By 2030, about three be living in developing countries compared out of every fi ve people in the world will live with 60% in 2005 (2). in cities and the number of urban dwellers in the less developed regions will be almost At the same time, our world is a growing four times as large as that in the more devel- city: as of 2007, over half of the global popu- oped regions (Fig. 2) (6). lation now lives in cities (3). Mega-cities,

Figure 1. Percent distribution of world population 60 or over by region, 2006 and 2050

35 34 2006 2050 30 27 25 25 24 24 21 20 17 14 Percent 15 10 10 9 9 9 5

0 Africa Asia Europe Latin North Oceania America America and the Caribbean

Source: United Nations Department of Economic and Social Affairs (1).

PAGE 3 Figure 2. Percentage of Urban Population in Major Areas

100 2005 87 84.3 2030 80.8 78.3 77.4 80 73.8 72.2 70.8 59.9 60 54.1 48.7 50.7 39.8 Percent 40 38.3

0 World Africa Asia Europe Latin North Oceania America America and the Caribbean

Source: United Nations Department of Economic and Social Affairs, Population Division (6).

More older people are also living in cities. economy”. Urban growth is associated with a Th e proportion of the older adult popula- country’s technological and economic devel- tion residing in cities in developed coun- opment. Vibrant cities beneﬁ t a country’s en- tries matches that of younger age groups at tire population – urban and rural. Because about 80%, and will rise at the same pace. cities are the centre of cultural, social and In developing countries, however, the share political activity, they are a hothouse for new of older people in urban communities will ideas, products and services that inﬂ uence multiply 16 times from about 56 million in other communities and therefore the world. 1998 to over 908 million in 2050. By that Yet to be sustainable, cities must provide time, older people will comprise one fourth the structures and services to support their of the total urban population in less devel- residents’ wellbeing and productivity. Older oped countries (7). people in particular require supportive and enabling living environments to compensate Population ageing and urbanization are the for physical and social changes associated culmination of successful human develop- with ageing. Th is necessity was recognized ment during last century. Th ey also are ma- as one of the three priority directions of jor challenges for this century. Living longer the Madrid International Plan of Action on is the fruit of critical gains in public health Ageing endorsed by the United Nations in and in standards of living. As stated in the 2002 (9). Making cities more age-friendly is WHO Brasilia Declaration on Ageing (8) in a necessary and logical response to promote 1996, “healthy older people are a resource the wellbeing and contributions of older ur- for their families, their communities and the ban residents and keep cities thriving. And

PAGE 4 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Part 2. Active ageing: a framework for age-friendly cities

Th e idea of an age-friendly city presented in • protecting those who are most vulner- this Guide builds on WHO’s active ageing able; and framework (10). • promoting their inclusion in and contri- Active ageing is the process of optimizing bution to all areas of community life. opportunities for health, participation and Active ageing depends on a variety of infl u- security in order to enhance quality of life ences or determinants that surround indi- as people age. viduals, families and nations. Th ey include material conditions as well as social factors In an age-friendly city, policies, services, that aff ect individual types of behaviour settings and structures support and enable and feelings (11). All of these factors, and people to age actively by: the interaction between them, play an im- • recognizing the wide range of capacities portant role in aff ecting how well individu- and resources among older people; als age. Many aspects of urban settings and services refl ect these determinants and are • anticipating and responding fl exibly to included in the characteristic features of an ageing-related needs and preferences; age-friendly city (Fig. 3). • respecting their decisions and lifestyle choices;

Figure 3. Determinants of Active Ageing

Gender

Health and Economic social services determinants

Behavioural Active determinants Social Ageing determinants

Personal determinants Physical environment Culture

PAGE 5 Th ese determinants have to be understood Because active ageing is a lifelong process, from a life course perspective that recog- an age-friendly city is not just “elderly- nizes that older people are not a homoge- friendly”. Barrier-free buildings and streets neous group and that individual diversity enhance the mobility and independence of increases with age. Th is is expressed in Fig. people with disabilities, young as well as 4, which illustrates that functional capacity old. Secure neighbourhoods allow children, (such as muscular strength and cardiovas- younger women and older people to venture cular output) increases in childhood, peaks outside in confi dence to participate in physi- in early adulthood and eventually declines. cally active leisure and in social activities. Th e rate of decline is largely determined by Families experience less stress when their factors related to lifestyle, as well as external older members have the community support social, environmental and economic factors. and health services they need. Th e whole From an individual and societal perspective, community benefi ts from the participation it is important to remember that the speed of older people in volunteer or paid work. of decline can be infl uenced and may be Finally, the local economy profi ts from the reversible at any age through individual and patronage of older adult consumers. Th e public policy measures, such as promoting operative word in age-friendly social and an age-friendly living environment. physical urban settings is enablement.

Figure 4. Maintaining functional capacity over the life course

Early Life Adult Life Older Age Growth and Maintaining highest Maintaining independence development possible level of function andpreventing disability

Range of function in individuals

Disability threshold* Functional Capacity Functional

Rehabilitation and ensuring the quality of life

Age

Source: Kalache & Kickbusch (12).

PAGE 6 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Part 3. How the Guide was developed

Cities in all WHO Regions each city have involved older people as full participants in the project. Project leaders A total of 35 cities from all continents par- sought the fi rst-hand experience of older ticipated in the WHO project leading to the people. What are the age-friendly features Guide, and 33 of these cities participated in of the city they live in? What problems do focus group research thanks to the collabo- they encounter? What is missing from the ration of government offi cials and nongov- city that would enhance their health, par- ernmental and academic groups (1). Th ese ticipation and security? cities represent a wide range of developed and developing countries (Fig. 5). Th ey Focus groups were set up with older people refl ect the diversity of contemporary urban aged 60 years and older from lower- and settings, including six current mega-cities middle-income areas. A total of 158 such with over 10 million inhabitants (Mexico groups, involving 1485 participants, were City, Moscow, New Delhi, Rio de Janeiro, organized between September 2006 and Shanghai and Tokyo), “almost mega-cities” April 2007. Older people were the main such as Istanbul, London and New York, as source of information in all the 33 cities well as national capitals, regional centres that conducted focus groups. To obtain the and small cities. views of people who would be unable to attend focus groups owing to physical or Bottom-up participatory approach mental impairment, most cities also held Th e bottom-up participatory approach a focus group with caregivers who talked (13) involves older people in analysing and about the experience of the older people for expressing their situation to inform govern- whom they were caring. ment policies. It is recommended by the To complement the information from United Nations for empowering older peo- older people and caregivers, most cities ple to contribute to society and to partici- also conducted focus groups with service pate in decision-making processes. Because providers from the public, voluntary and older people are the ultimate experts on commercial sectors. In all, 250 caregivers their own lives, WHO and its partners in and 515 service providers were included in the consultations. Th ese people made ob- 1. Edinburgh contributed information on the city’s age- servations based on their interactions with friendliness, based on a large survey and individual interviews collected a few months prior to the WHO older people. Th e caregivers and service project. The information from Edinburgh, using a dif- providers sometimes provided information ferent but complementary methodology, provided additional confi rmation of the fi ndings from focus groups. that older people did not report, but the New York City was closely involved in the data analysis information from both groups was always and in the development of the next phases of the Global Age-Friendly Cities project. consistent with the views expressed by

PAGE 7 Figure 5. World map of age-friendly partner cities

Americas Africa UK, Edinburgh Argentina, La Plata Kenya, Nairobi UK, London Brazil, Rio de Janeiro Canada, Halifax Eastern Mediterranean South-east Asia Canada, Portage la Prairie Jordan, Amman India, New Delhi Canada, Saanich Lebanon, Tripoli India, Udaipur Canada, Sherbrooke Pakistan, Islamabad Costa Rica, San Jose Western Pacific Jamaica, Kingston Europe Australia, Melbourne Jamaica, Montego Bay Germany, Ruhr Australia, Melville Mexico, Cancun Ireland, Dundalk China, Shanghai Mexico, Mexico City Italy, Udine Japan, Himeji Puerto Rico, Mayaguez Russia, Moscow Japan, Tokyo Puerto Rico, Ponce Russia, Tuymazy USA, New York Switzerland, Geneva USA, Portland Turkey, Istanbul

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.

older people. structures, environment, services and policies that reﬂ ect the determinants of active Discussion topics ageing. Th e topics had been identiﬁ ed in A total of eight topics were explored in previous research with older people on the the focus groups to give a comprehen- characteristics of elderly-friendly com- sive picture of the city’s age-friendliness. munities (14,15). Th e same basic questions Th e topics cover the features of the city’s

PAGE 8 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

about each area were asked in the focus social environment and to the economic groups in all cities. determinants of active ageing. Th e last two topic areas, communication and informa- Th e fi rst three topics were outdoor spaces tion and community support and health and buildings, transportation, and housing. services, involve both social environments As key features of a city’s physical envi- and health and social service determinants. ronment, they have a strong infl uence on Th e cross-cutting active ageing determi- personal mobility, safety from injury, secu- nants of culture and gender were included rity from crime, health behaviour and social only indirectly in this project, because participation. Another three topics refl ect their infl uence on active ageing extends far diff erent aspects of the social environment beyond urban living. Owing to their over- and of culture that aff ect participation and riding infl uence, these determinants merit mental wellbeing. Respect and social inclu- specially focused initiatives. sion deals with the attitudes, behaviour and messages of other people and of the commu- As with the determinants of active age- nity as a whole towards older people. Social ing, these eight aspects of city life overlap participation refers to the engagement of and interact. Respect and social inclusion older people in recreation, socialization, and are refl ected in the accessibility of the cultural, educational and spiritual activities. buildings and spaces and in the range of Civic participation and employment ad- opportunities that the city off ers to older dresses opportunities for citizenship, unpaid people for social participation, entertain- work and paid work; it is related to both the ment or employment. Social participation, in turn, infl uences social inclusion, as well

Figure 6. Age-friendly city topic areas

Transportation

Housing Outdoor spaces and buildings Age- Social participation friendly Respect and city social inclusion vices Civic participation munity support and employment Com and health ser

Communication and information

PAGE 9 as access to information. Housing aﬀ ects aspects of the city, the barriers and gaps, needs for community support services, and the suggestions for improvement while social, civic and economic participa- voiced by focus group participants in all tion partly depend on the accessibility and cities were transcribed and grouped into safety of outdoor spaces and public build- themes. Th e themes that were mentioned ings. Transportation and communication in each city were recorded to form a picture and information particularly interact with of what was most important overall and in the other areas: without transportation or diﬀ erent regions and cities. Based on the adequate means of obtaining information to themes, a checklist of the core features of allow people to meet and connect, other ur- an age-friendly city was developed in each ban facilities and services that could support area of city living. Th e checklist is a faith- active ageing are simply inaccessible. Fig. 6 ful summary of the views expressed by the depicts the age-friendly city topic areas. focus group participants worldwide.

Identifying age-friendly features For each topic, the reports of age-friendly

PAGE 10 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Part 4. How to use the Guide

Core age-friendly features Who will use the Guide? Th e purpose of this Guide is to help cit- Th e Guide is intended to be used by indi- ies see themselves from the perspective of viduals and groups interested in making older people, in order to identify where and their city more age-friendly, including gov- how they can become more age-friendly. ernments, voluntary organizations, the pri- Th e following parts of the Guide describe, vate sector and citizens’ groups. Th e same for every area of city life, the advantages principle followed in creating the Guide ap- and barriers that older people experience plies to using it; that is: involve older people in cities at diﬀ erent stages of development. as full partners at all stages. In assessing Th e checklist of core age-friendly features the city’s strengths and gaps, older people concluding each part applies to less devel- will describe how the checklist of features oped as well as more developed cities. It is matches their own experiences. Th ey will intended to provide a universal standard for provide suggestions for change and they an age-friendly city. may participate in implementing improvement projects. Th e situation of older people Th e age-friendly features checklist is not a articulated through this bottom-up ap- system for ranking one city’s age-friendli- proach provides the essential information ness against another’s; rather, it is a tool for to be distilled and analysed by gerontology a city’s self-assessment and a map to chart experts and decision-makers in developing progress. No city is too far behind to make or adapting interventions and policies. In some signiﬁ cant improvements based on the follow-up stages of “age-friendly” local the checklist. Going beyond the checklist action, it is imperative that older people is possible, and indeed some cities already continue to be involved in monitoring the have features that exceed the core. Th ese city’s progress and acting as age-friendly good practices provide ideas that other cities city advocates and advisers. 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).

PAGE 11 Part 5. Outdoor spaces and buildings

Overview of fi ndings You get out of your bed at four o’clock in the Th e outside environment and public build- morning instead of six o’clock because there ings have a major impact on the mobility, is too much noise outside. independence and quality of life of older Older person, Istanbul people and aff ect their ability to “age in place”. In the WHO project consultation, In Tripoli, the smell of smoke from nar- older people and others who interact sig- guileh (oriental water pipes) is said to be nifi cantly with them describe a broad range “suff ocating”, especially in the evenings and of characteristics of the urban landscape during Ramadan. In Jamaica, concern is and built environment that contribute to expressed at the loudness of music, com- age-friendliness. Th e recurring themes in pounded by the explicit language used in cities around the world are quality of life, the songs. In a number of cities, the per- access and safety. Improvements that have ceived dirtiness of the city detracts from been made or that are under way in cities at older residents’ quality of life. To address all stages of development are welcomed by these problems, people in Mexico City those consulted, who also point out other suggest that a “clean street” campaign be changes that ought to be made. organized, while in Jamaica, regulations ad- 1. Pleasant and clean environment dressing noise levels are recommended. Th e beauty of the city’s natural surround- Th e size of the city is thought to be a prob- ings is a feature that people in many cities lem in some cities. Th e increasing numbers mention spontaneously as an age-friendly of people in Tokyo are thought to be linked feature. For example, in Rio de Janeiro and to a reduction in community cohesiveness. Cancún, living close to the ocean is seen Nairobi is considered to be overcrowded as a defi nite advantage, as is living close to and diffi cult for older people to get around. the river in Melville and London. In Himeji, older people value the quiet and peaceful- ness 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.

PAGE 12 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

2. Importance of green spaces 3. Somewhere to rest Having green spaces is one the most com- Th e availability of seating areas is gener- monly mentioned age-friendly features. ally viewed as a necessary urban feature for However, in many cities there are barriers older people: it is diffi cult for many older that prevent older people from using green people to walk around their local area with- spaces. In New Delhi, for example, some out somewhere to rest. green spaces are said to be poorly maintained and have become “dumps”, and in There are very few seating areas … you get Himeji, some parks are considered to be tired and need to sit down. unsafe. Concern is expressed in Melville Older person, Melville about the inadequate toilet facilities and lack of seating. In Moscow it is reported Older people and caregivers in Shanghai that there is no protection from the weath- appreciate the relaxing rest areas in their er, while in Udaipur diffi culties in getting city. In Melbourne, the redevelopment of to the parks are highlighted. Another issue outdoor seating areas is viewed positively. of concern is hazards resulting from shared Yet there is some concern about encroach- use of the park. ment into public seating areas by people or groups who are intimidating or who dis- It may be a limiting factor to an older person play antisocial behaviour. In Tuymazy, for going into a park that might be a shared activity area with bikes whizzing by, or example, it was requested that the public skateboards or roller-bladers, or large bound- seating be removed for this very reason. ing four-legged beasts. 4. Age-friendly pavements Service provider, Melbourne Th e condition of pavements has an obvious impact on the ability to walk in the local Diff erent suggestions are off ered to resolve area. Pavements that are narrow, uneven, these problems. Caregivers in Halifax see cracked, have high curbs, are congested or a need for small, quieter, contained green have obstructions present potential hazards spaces in the fringe areas of the city rather and aff ect the ability of older people to walk than the large busy parks used by children around. and skateboarders. Older people in Amman recommend special gardens for their age I had a fall due to the pavement. I broke my group, while older people in New Delhi shoulder. suggest demarcated areas in parks for older people. Better park maintenance is called Older person, Dundalk for in several locations. 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 13 share the pavements with street vendors. 5. Safe pedestrian crossings In other cities, such as La Plata, Moscow, Th e ability to cross the road safely is an Ponce and the Ruhr metropolitan region, often mentioned concern, and it is reported cars parked on the pavement force pedes- that several cities have taken steps to im- trians to walk on the road. Th e weather prove the conditions for people crossing the may compound the diffi culties experi- road: traffi c lights at pedestrian crossings in enced by older people using pavements. In Cancún; traffi c islands in La Plata; pedes- Sherbrooke, for example, concern is ex- trian crossings in Mayaguez, and non-slip pressed about snow not being cleared from strips on pedestrian crossings in Portland. the pavements and in Portage la Prairie, the Amman has built bridges and tunnels to risk of falls is considered greater after it has assist pedestrians to cross roads. snowed. In quite a few cities, it is reported that Approval is expressed for improvements the pedestrian crossing lights change too that some cities are making to the design quickly. In Melville, it is suggested that the and maintenance of pavements. Th e follow- crossing lights have a visual “countdown” so ing features to make pavements age-friend- that pedestrians know how much time they ly are often suggested: have to cross the road. Th e auditory signals • a smooth, level, non-slip surface; at pedestrian crossings are much appreciated in Istanbul, and in Portland and Udine, • suffi cient width to accommodate wheel- auditory as well as visual cues at crossings chairs; are recommended. • dropped curbs that taper off to be level with the road; Cross lights are made for Olympic runners.

• clearance from obstructions such as Older person, Halifax street vendors, parked cars and trees; and • priority of access for pedestrians. Another common concern is that drivers fail to follow traﬃ c signals and do not give I don’t live downtown, I live in La Loma, but way to pedestrians. we have the same problem with the side- walks and stuff. It is hard for me to walk, … there are pedestrian crossings but motor- I use a cane, and I’m all the time looking ists have no respect for pedestrians. They down, as a friend of mine used to say. Now see you on the thing and they come right up when I’m walking round downtown and ask on you. If your heart is not strong you drop for help to go across 7th street, I always see if down. I can ﬁ nd a young person or so, and people come to me, so I can’t complain about that, Older person, Jamaica about people helping.

Older person, La Plata

PAGE 14 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

In most of the cities, the volume and speed 7. A secure environment of road traffi c is said to present barriers for Feeling secure in one’s living environment older people, both as pedestrians and as strongly aff ects people’s willingness to drivers. In Udaipur, it is reported that the move about in the local community, which traffi c is chaotic and older people fear going in turn aff ects their independence, physi- out because of heavy traffi c; some will not cal health, social integration and emotional go out unless they are accompanied. (Th e well-being. Many cities are considered to diffi culties encountered by older drivers are be generally safe from harm by others, but discussed in Part 7.) others clearly are not. Regardless of the ac- 6. Accessibility tual level of danger, concerns about security are expressed nearly everywhere, including In both developed and developing coun- matters such as street lighting, violence, tries, people think that their city was not crime, drugs and homelessness in public designed for older people. places. Going out at night is especially fearful for many older people. I only go into town when I have something specifi c to do. I go there and fi nish what I am We are not going out in the evenings. I don’t doing and come straight back home. Why go anywhere … they might kill you. would I want to walk around the city? I am not a young person. Older person, Tuymazy Older person, Nairobi It is acknowledged that some cities have In many cities, reference is made to barri- taken measures to improve security; for ers to physical access, which can discour- example, it is pointed out that Geneva and age older people from leaving their homes. Sherbrooke have installed surveillance In Rio de Janeiro, it is pointed out that the cameras. concrete ladders to access the favela (shanty A suggestion made in La Plata to improve town) are diffi cult for older people to use. security is to involve the community, such Th e lack of ramps in some areas is an issue as promoting self-organized groups among in Sherbrooke. Th e common recommenda- older people for greater outdoor safety as tion for addressing these concerns is educa- well as providing more police. In Dundalk, tion, particularly for urban planners and it is suggested that the government provide architects, about the needs of older people. 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 15 9. Age-friendly buildings We should have an empty space to feel safe from the earthquakes, but they don’t give us, In many cities, including Himeji, Mayaguez, they tell us to use the streets. Melbourne and New Delhi, reference is made to new buildings being accessible and Older person, Istanbul improvements being made to make buildings more accessible. Generally, the features 8. Walkways and cycle paths that are considered necessary for buildings Walkways and cycle paths are seen as to be age-friendly are: part of a health promoting, age-friendly • elevators environment, yet there are hazards noted as well. In Geneva, cyclists are thought • escalators by some to be a danger to older people. • ramps In Udine, it is suggested there should be • wide doorways and passages two pathways – one for cyclists and one for pedestrians. Older people in Cancún, • suitable stairs (not too high or steep) with Portland and Saanich value the walking railings trails provided in their cities. Th e need to • non-slip ﬂ ooring ensure walkways have a smooth surface is • rest areas with comfortable seating highlighted by caregivers in Halifax, and the need to ensure they are easy to access • adequate signage with suﬃ cient wheelchair access points is • public toilets with handicap access. mentioned by older people and caregivers in Portage la Prairie. Older people in Udine In two cities, however, barriers to older advise developing a system of walkways people using elevators are mentioned. In to move through the area, and in Halifax, Nairobi, older people have a fear of using el- walkways in car parks are called for to evators and need to be accompanied; while ensure the safety of pedestrians. Adding in Tripoli, older people are reluctant to use public toilets near walkways is another idea elevators as electricity failures are common put forward in Saanich. 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 16 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH large shopping centres are also mentioned. 11. Older customers In Dundalk and Melville, some shop- Good customer service that appreciates the ping centres provide wheelchairs for their needs of older people is considered to be an customers and have wheelchair access. In age-friendly feature. Preferential treatment Melbourne, the need to walk long distances is given to older people in Cancún, and in is seen as a barrier to using large shopping Jamaica, some businesses provide wheel- centres. In Istanbul, shopping centres have chairs for older customers. In Mexico City, escalators but older people fi nd them dif- priority service is provided to older people fi cult to use. by law. In Portland, an “elderly-friendly” It is considered that buildings, including business guide and audit system has been shops, should be located close to where developed by a voluntary group. older people live to enable them to have One of the barriers identifi ed in a number easy access to these services and facilities. of cities is the long queues or waiting times Older people in Tuymazy appreciate living older people face to be served. It is sug- close to stores and markets. Th e clustering gested that special service arrangements of businesses in Sherbrooke allows older be made for older people, such as separate people to do their transactions within a queues or service counters. Older people in small radius of their homes. Islamabad recommend giving older women 10. Adequate public toilets priority in queues. In Sherbrooke, it is suggested that seats be placed in businesses, Th e availability of clean, conveniently locat- such as banks, where older people are ed, well-signed, handicap-accessible toilets required to wait. is generally regarded as an important age- friendly feature of the built environment. In Another barrier identifi ed in some cities, Islamabad, appreciation is expressed for the including London and Tokyo, is the disap- recently introduced public toilets, which pearance of the local shop or convenience are increasing in number. store. With their closing, older people lose a potential source of social contact and are A number of barriers are identifi ed in rela- required to travel further to shop. tion 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.

PAGE 17 Age-friendly outdoor spaces and buildings checklist Environment Pavements • Th e city is clean, with enforced regula- • Pavements are well-maintained, smooth, tions limiting noise levels and unpleasant level, non-slip and wide enough to ac- or harmful odours in public places. commodate wheelchairs with low curbs that taper off to the road. Green spaces and walkways • Pavements are clear of any obstructions • Th ere are well-maintained and safe green (e.g. street vendors, parked cars, trees, spaces, with adequate shelter, toilet dog droppings, snow) and pedestrians facilities and seating that can be easily have priority of use. accessed. Roads • Pedestrian-friendly walkways are free from obstructions, have a smooth sur- • Roads have adequate non-slip, regularly face, have public toilets and can be easily spaced pedestrian crossings ensuring that accessed. it is safe for pedestrians to cross the road. Outdoor seating • Roads have well-designed and appropriately placed physical structures, such as • Outdoor seating is available, particularly traffi c islands, overpasses or underpasses, in parks, transport stops and public spac- to assist pedestrians to cross busy roads. es, and spaced at regular intervals; the seating is well-maintained and patrolled • Pedestrian crossing lights allow suffi cient to ensure safe access by all. time for older people to cross the road and have visual and audio signals.

PAGE 18 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Traffi c Buildings • Th ere is strict enforcement of traffi c rules • Buildings are accessible and have the fol- and regulations, with drivers giving way lowing features: to pedestrians. – elevators Cycle paths – ramps • Th ere are separate cycle paths for cyclists. – adequate signage Safety – railings on stairs • Public safety in all open spaces and – stairs that are not too high or steep buildings is a priority and is promoted – non-slip fl ooring by, for example, measures to reduce the risk from natural disasters, good street – rest areas with comfortable chairs lighting, police patrols, enforcement of – suffi cient numbers of public toilets. by-laws, and support for community and personal safety initiatives. Public toilets Services • Public toilets are clean, well-maintained, easily accessible for people with varying • Services are clustered, located in close abilities, well-signed and placed in conve- proximity to where older people live and nient locations. 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.

PAGE 19 Part 6. Transportation

Overview of fi ndings disabled or frail older people, taxis, and personal drivers. Yet in cities at all stages of Transportation, including accessible and development, there are gaps reported that aff ordable public transport, is a key factor need to be addressed to make the commu- infl uencing active ageing. It is a theme run- nity more age-friendly. ning through many other areas of discussion. In particular, being able to move 2. Aff ordability about the city determines social and civic Cost is viewed as a signifi cant factor aff ect- participation and access to community and ing older people’s use of public transport. health services. In some cities, free or subsidized public People consulted in the WHO project transport for older people is said to be pro- therefore have a lot to say on the topic, cov- vided. Geneva reportedly off ers free trans- ering every aspect of infrastructure, equip- port for someone accompanying an older ment and service for all means of urban person, and in Dundalk, people 75 years transportation. and older are entitled to a Companion Pass. In some cities, however, the cost of public For many older people, their lives are guided transport is considered to be too expensive. by the available transport system. Older people in Nairobi complain about the Service provider, Dundalk arbitrary price increases charged because of bad weather, public holidays and peak travel periods. Diffi culties getting subsidized or 1. Availability free fares are mentioned. In Himeji, it is Public transport services are said to be said that the eligibility age for the com- available in almost all of the cities, although plimentary pass is too high, while in New not in all areas. Cities in developed coun- Delhi, the application process for conces- tries and those with a transition economy sion travel is considered to be cumbersome. (e.g. the Russian Federation) are more In Rio de Janeiro, free transport is not likely to indicate that their public transport provided to the older people who live in the system is well-developed or satisfactory. A favela, as public transport does not service range of transport services are available in this area. In Geneva, discounted travel can many cities, including buses (private and only be obtained if older people purchase a public), trains, trams, trolleybuses, rick- railway season ticket. Subsidized fares can- shaws (private and public), shuttle buses and minibuses, community (voluntary) transport services, services specifi cally for

PAGE 20 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

not be used for private transport services In a few cities, such as Geneva, London, in some cities, although in Dundalk, free Moscow and Tokyo, people indicate that travel passes are accepted on some private their public transport services are reli- bus services. able but this is not always the case in other similarly developed cities. Th is was not an People in some cities suggest that free age-friendly feature reported in develop- transport or subsidized transport be ing cities. In Amman, there is no fi xed provided or extended for older people. In timetable for the buses, and in Islamabad, Mexico City, it is suggested that free trans- there is no fi xed timetable for public service port be provided for older people to attend vehicles. In La Plata, the buses are unreli- specifi c events. able as the routes are often changed.

3. Reliability and frequency 4. Travel destinations Having frequent and reliable public trans- Th e ability to use public transport depends port services is identifi ed as an age-friendly very much on being able to get to where feature. Some older people, especially in de- you want to go. People in quite a few cities veloped countries, indicate that the frequen- state that their public transport services cy of their city transport services is good. provide good coverage of at least some ar- Nevertheless, there are a number of reports eas, enabling people to get to their desired from cities at varying stages of develop- destination. But concern is expressed in ment that public transport services are not other cities in both developed and develop- frequent or reliable enough. In Istanbul, ing countries about the adequacy of public older people indicate that travelling by transport routes; people complain that sev- public transport takes a very long time eral areas of the city are not covered, or it is as it is not frequent. In Melbourne, some diffi cult to cross the entire city, or there are areas are said to have no bus service from poor connections between buses and other Saturday afternoon until Monday morning. means of transport. In addition, important In the Ruhr metropolitan area, older people destinations of older people are not well- consider that public transport to the outer served. For instance, the bus in Dundalk areas of the city and at night is not frequent does not travel to one of the nursing homes, enough. In some cities, it is suggested that and in Mayaguez, there is limited transpor- public transport be more frequent, particu- tation to the seniors’ centres. In Tuymazy, larly at night and at weekends. access by public transport to public gardens is considered insuffi cient.

PAGE 21 6. Specialized services for older The thing with public transit, there are big people holes ... if you want to go downtown you’re in great shape, if you want to go across town Older people who have diffi culties using you’re going to have to struggle. public transport need to have specially Older person, Portland adapted means of transport. Th ese are mentioned as an age-friendly feature in some cities in developed countries, but in 5. Age-friendly vehicles others there are few such options available. Boarding and disembarking from vehicles is Recommendations are made to provide another major issue raised. A number of cit- services for people with disabilities. For ies are reported to have some public trans- example, in Rio de Janeiro, caregivers men- port vehicles that are modifi ed to provide tion that taxis are the only available means easier access for older people: in Shanghai, of transport for older people with disabili- modifi ed seating is provided; in Saanich, ties, but that their wheelchairs cannot fi t there are some accessible buses; and in into the boot of the vehicle because the Udaipur, a public bus service is starting soon petrol tank is located there. In Mexico City, with low-fl oor buses. In Geneva, some buses caregivers suggest the provision of adapted have raised platforms and low fl oors. buses specifi cally for disabled people and their caregivers. People commonly observe that the design of public transport vehicles presents barri- 7. Priority seating and passenger ers to older people. In Udine, for example, courtesy the older people say that it is diffi cult to use A few cities indicate that having priority buses owing to the high steps on the buses, seating on public transport for older people and in Ponce, buses are not adapted for is an age-friendly feature and in some cities, wheelchair access. such as Islamabad, passengers do respect Residents in a small number of cities also the priority seating for older people. Th is mention other features that discourage courtesy is not common, however, and pub- the use of public transport. In New Delhi, lic education on courtesy in public trans- older people point out that the bus route portation is recommended by, for example, numbers are not clearly displayed on public older people in Moscow. service buses. Th e service providers in Dundalk question the roadworthiness of 8. Transport drivers some buses, and in La Plata, older people In some cities, courteous transport driv- express concern about the deteriorated ers are described as an age-friendly feature condition of some buses. 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 22 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

One of the major concerns raised is that A fi nal issue identifi ed in a few develop- drivers do not wait for older people to be ing cities is exploitation by drivers. For seated before starting off . example, in New Delhi, some rickshaw drivers overcharge their passengers, and in I can get on the bus but the minute the man Nairobi, fares are changed very arbitrarily. takes off the bus rocks and I’m fl at on my face. Not surprisingly, in quite a few cities it is suggested that drivers should be educated Older person, Saanich to be sensitive to the needs of older people. Th e driver training programme that has In Rio de Janeiro, it is pointed out that been implemented in Sherbrooke is regard- many middle class older people take a taxi ed as a benefi t for older passengers. or the metro rather than ride in a bus, because they are afraid of falling in a bus. In a small number of cities, it is suggested other transport staff , for example counter A particular problem identifi ed in devel- staff , should also be educated about the oping cities, such as Amman, is drivers’ needs of older people and how this aff ects reluctance to pick up older people. In Delhi their use of transport services. and Geneva, older people highlight the diffi culties caused when bus drivers do not 9. Safety and comfort stop close enough to the curb to enable Whether or not people feel safe using pub- them to get on and off the bus safely. People lic transport has a signifi cant eff ect on their in Dundalk mention that bus drivers stop at willingness to use these services. In a few unmarked locations, which is often danger- cities, it is reported that public transport is ous, particularly at road corners. In Geneva safe. In Cancún it was mentioned that there and Ponce, some bus drivers are said to be is less crime on public transport services to be impolite. than in other cities, and in Melbourne and Other identifi ed barriers include careless driv- Moscow, public transport is deemed to be ing and disregard for the rules of the road. safe. Yet even in places where some people consider public transport safe to use, for They drive like mad … with very loud music. example London, it is still suggested that steps be taken to further improve safety. In Older person, Mexico City the many cities where reservations about the safety of public transport are expressed, the issues are theft or antisocial behaviour.

PAGE 23 10. Transport stops and stations The main problem is getting on and off the buses. Which of your pockets are you going Th e design, location and condition of to control? While you are looking after your transport stops and stations are signifi cant pocket, you see that your purse has gone. features as well. In Shanghai, older people Older person, Istanbul. and caregivers value the benches, shelter and lighting provided at some transport In many cities, crowded public transport, stops. In Ponce, the bus stops and terminal particularly during peak times (the “rush are kept in good condition. In Portland, hour”), also presents safety issues for older convenient access to transport stops is people. Th is problem is more commonly viewed with satisfaction. identifi ed in developing cities and in the Th e location of transport stops presents Russian cities. For example, in Jamaica, some diffi culties for older people. Problems pushing and shoving is reported to be a are encountered in Melbourne when there problem for older people at bus stops and are few bus stops and the distance between on boarding buses. In Moscow, it is pointed the stops is too great. In Melville, older out that crowding makes it diffi cult to people express concern about having to breathe in the railway station. cross a major road to get to the bus stop. In A few developed cities, like Dundalk, Saanich, some older people mention that Portland and Saanich, also mention dif- bus stops are too far from their homes. fi culties related to overcrowded public In some cities, there are issues of safety at transport. transport stops. In Moscow, it is reported that there are pickpockets in the crowds You can’t breathe on it [train from Dublin]. If at the transport stops, and in Melbourne, you collapsed nobody would know – you’re there are complaints about vandalism at wedged up! bus stops. In Melville, a programme by Older person, Dundalk which children decorate bus stops is believed to have reduced vandalism. In Nairobi, older people note with satis- In San José, the lack of shelter at transport faction that overcrowding problems have stops is perceived as a disadvantage, as is signifi cantly improved since the introduc- the lack of seating at transport stops in tion of legislation, the Michuki Rules, to Shanghai. In Tokyo, however, it is pointed ensure the required seating capacity is not out that placing benches at bus stops makes exceeded. In Tuymazy, providing more it diffi cult for people with disabilities to buses during peak times is suggested, while walk around them, because the streets are in Saanich, it is recommended that older very narrow. people be encouraged to use public transport outside peak times.

PAGE 24 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

People in many cities consider that railway 12. Community transport stations and bus terminals should be easy Th e availability of community transport to get to and should have an age-friendly services (i.e. free transportation pro- design with ramps, escalators, elevators, vided by the voluntary or private sector) public toilets and clearly visible signage. In is considered to be an age-friendly service Tokyo, older people and caregivers value more often mentioned by people in devel- the lift that was installed in the metro oped than in developing cities. In Ponce, station. In the Ruhr metropolitan region, for example, there is free transportation older people consider the lack of facilities provided by seniors’ centres to attend medi- as the main railway station to be a barrier cal appointments, and in Portage la Prairie to transporting luggage and wheelchairs community volunteer drivers and the up to the platforms. In New Delhi, older shuttle service provided by grocery stores people point out that the metro station is are valued services. In London, a suggested not located close to where they live and that service is community transport with fully signage at the station is inadequate. accessible buses and drivers trained to 11. Taxis serve older people. Taxi services are viewed as an age-friendly 13. Information transportation option in a number of cit- In a few cities, there is mention of the ies. In Cancún, taxis are considered to be importance of having information on aff ordable. In Dundalk, older people value transport options, on how to use transport the discounted fares provided by taxi services, and on timetables. In Portland, for services. In Melville, caregivers appreciate example, programmes are provided to teach the government subsidy scheme for the use older people how to use public transport. of taxis. In Halifax, it is said that some taxi In Melville, it is suggested that older people drivers are very helpful to older people, and who can no longer drive be off ered a course in Tripoli, it is reported that taxis provide a on how to use public transport. In Himeji, good and convenient service. it is suggested that bus timetables indicate In other cities, barriers are identifi ed in the whether the bus is one that is accessible to use of taxis. Cost is one barrier and lack of people with disabilities. Older people in disability access is another. In Portage la Tokyo identify the need for timetables to be Prairie, caregivers are concerned that taxi in larger print and conveniently located. 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.

PAGE 25 14. Driving conditions traffi c rules and regulations. For example, in Rio de Janeiro, the heavy traffi c is viewed Driving as an essential transportation op- as a barrier. In Cancún the older people tion for older people is discussed in a few complain that the roads have holes and are locations. For example, it is observed that generally in a bad condition. In Melville, Melville is a city designed for cars, and in concerns are raised about ineff ective traf- Himeji, cars are considered a necessity in fi c calming devices such as roundabouts, the suburbs. In Ponce, cars are viewed as which are either too small or are placed in necessary because of the limited transport inappropriate places. In Mayaguez, older options available. people report that streets are not well-lit. In People in a few cities indicate that it is easy Halifax, the street signage is considered too to drive around the city, a feature more small, too high and often obscured. Older likely to be mentioned by those in devel- people in Udine report that drivers do not oped countries. In Portage la Prairie, the respect traffi c regulations. In Sherbrooke, traffi c is said to be light and driving easy. other drivers are said to be often aggressive. In Saanich, the older people appreciate the advance warnings of crossroads. In Tokyo, 15. Courtesy towards older drivers older people mention that the road signals In addition to the barriers identifi ed above, and signs are easy to see. Th e streets of the disrespect shown to older drivers dis- Tripoli are considered to be well-marked, courages a number of them. and in Shanghai, the traffi c management is viewed as good. I dislike driving. People curse you, make signs at you if you go slow. They are impolite. People in many more cities in countries at all stages of development report barriers Older person, Tripoli to city driving. Th ese include heavy traffi c, poor condition of roads, ineff ective traffi c In La Plata, it is stated that older drivers calming devices, inadequate street light- are abused because they drive too slowly. ing, inadequate signage that is obscured In Cancún, older people feel unsafe when or poorly positioned, and the disregard for 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 26 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

In many cities, however, inadequate and In some cities, such as Portage la Prairie, costly parking facilities are identifi ed as where driving is an essential transport op- barriers for older people. Other problems tion, concerns are raised about the diffi cul- are mentioned too. In Mayaguez, it is said ties that older people face when giving up that there are not enough drop-off and their licences. To ensure older people are pick-up points for older people with dis- confi dent drivers, refresher courses are rec- abilities, while in Portage la Prairie, it is ommended in some cities such as including pointed out that the parking bays are not Geneva and Portland. Th e special lessons wide enough for loading wheelchairs. In given to older people in Himeji when they Saanich, the lack of handicap parking bays need to renew their licence is viewed as an is raised as an issue. In Melbourne, con- age-friendly advantage. cern is expressed about the inability to 16. Parking fi nd parking close to buildings. One other concern expressed is the lack of respect for Priority parking bays for older and handi- priority handicap parking bays. capped people in close proximity to buildings, together with drop-off and pick-up They make disabled bays that are totally and bays, were seen as age-friendly features. utterly ignored. In Amman, older people value the bays Older person, London 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.

PAGE 27 Age-friendly transportation checklist

Aff ordability Specialized services • Public transportation is aff ordable to all • Suffi cient specialized transport services older people. are available for people with disabilities. • Consistent and well-displayed transpor- Priority seating tation rates are charged. • Priority seating for older people is provid- Reliability and frequency ed, and is respected by other passengers. • Public transport is reliable and frequent Transport drivers (including services at night and at week- • Drivers are courteous, obey traffi c rules, ends). stop at designated transport stops, wait Travel destinations for passengers to be seated before driving off , and park alongside the curb so that • Public transport is available for older it is easier for older people to step off the people to reach key destinations such as vehicle. hospitals, health centres, public parks, shopping centres, banks and seniors’ Safety and comfort centres. • Public transport is safe from crime and is • All areas are well-serviced with adequate, not overcrowded. well-connected transport routes within the city (including the outer areas) and Transport stops and stations between neighbouring cities. • Designated transport stops are located • Transport routes are well-connected in close proximity to where older people between the various transport options. live, are provided with seating and with shelter from the weather, are clean and Age-friendly vehicles safe, and are adequately lit. • Vehicles are accessible, with fl oors that • Stations are accessible, with ramps, esca- lower, low steps, and wide and high seats. lators, elevators, appropriate platforms, • Vehicles are clean and well-maintained. public toilets, and legible and well-placed signage. • Vehicles have clear signage indicating the vehicle number and destination. • Transport stops and stations are easy to access and are located conveniently. • Station staff are courteous and helpful.

PAGE 28 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Information • Roads are free of obstructions that might block a driver’s vision. • Information is provided to older people on how to use public transport and about • Th e rules of the road are strictly enforced the range of transport options available. and drivers are educated to follow the rules. • Timetables are legible and easy to access. • Timetables clearly indicate the routes of Driving competence buses accessible to disabled people. • Refresher driving courses are provided and promoted. Community transport • Community transport services, including Parking volunteer drivers and shuttle services, are • Aff ordable parking is available. available to take older people to specifi c • Priority parking bays are provided for events and places. older people close to buildings and trans- Taxis port stops. • Taxis are aff ordable, with discounts or • Priority parking bays for disabled people subsidized taxi fares provided for older are provided close to buildings and trans- people with low incomes. port stops, the use of which are moni- tored. • Taxis are comfortable and accessible, with room for wheelchairs and/or walk- • Drop-off and pick-up bays close to building frames. ings and transport stops are provided for handicapped and older people. • Taxi drivers are courteous and helpful. Roads • 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.

PAGE 29 Part 7. Housing

Overview of fi ndings For example, in Geneva it is reported that some older people are living in houses that Housing is essential to safety and well-be- are too big for them but, because they are ing. Not surprisingly, people consulted pensioners, they cannot aff ord to move. by WHO in all regions have much to say Similarly, in Tuymazy, it is stated that the on diff erent aspects of housing structure, cost of moving house is too expensive and design, location and choice. Th ere is a link not possible for retirees. Free or low-cost between appropriate housing and access to public housing is regarded as a defi nite age- community and social services in infl uenc- friendly advantage in some cities, such as ing the independence and quality of life of London. In other cities, such as Islamabad, older people. It is clear that housing and the lack of low-income housing is seen as support that allow older people to age com- a barrier. Th e need to have information fortably and safely within the community about subsidized housing is highlighted in to which they belong are universally valued. Portage la Prairie. 1. Aff ordability I’ve got a terraced house, council, rent-free. Th ere is general agreement among the cities I love it. that the cost of housing is a major factor infl uencing where older people live and their Older person, London quality of life. While in some cities the cost of housing, including rent, is considered to In cities in countries at all stages of devel- be aff ordable, in others housing is regarded opment, it is recommended that aff ordable as expensive, making it diffi cult for older housing be available for older person. Ideas people to move to more appropriate housing. include a lower level of tax on housing for older people in Amman, and having a hous- I have my retirement salary but how can I ing subsidy for public and private housing live with this little money? It comes into my in Himeji. house and it goes away in a few seconds.

Older person, Istanbul

PAGE 30 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

2. Essential services has even surfaces; has an elevator if it is multi-level accommodation; has appropri- In a small number of cities, essential ser- ate bathroom and kitchen facilities; is large vices are found to be inadequate or very enough to move about in; has adequate expensive. In Islamabad, houses in low- storage space; has passages and doorways income areas have no electricity, gas or large enough to accommodate a wheelchair; water supply. In Moscow, the public utility and is appropriately equipped to meet the services are considered to be expensive. ambient environmental conditions. In Dundalk and Istanbul, older people are concerned by the high costs of heating and Problems with housing construction are think that the government should assist mentioned in a few cities. In Mexico City, with heating costs. In Jamaica, older people people identify the need for supervised on a low income fi nd it diffi cult to pay the construction to ensure that the housing is high utility costs and suggest that these structurally sound. Poverty is said to result costs should be reduced. in poorly constructed or maintained housing in Istanbul, and in Nairobi, the lack of When they send me the water bill it costs available construction materials is a source me $1000. I can’t afford it so I don’t use the of concern. In Islamabad, some housing is shower and sometimes there is no water. not earthquake-proof. Older person, Jamaica A number of structural features are identifi ed as barriers. Home layout that impedes In Rio de Janeiro, older people value the im- mobility is a problem identifi ed in Dundalk. provements that have been made in water, In La Plata, stairs and uneven fl oors are ex- sanitation and electricity services, and in perienced as barriers. In Moscow, the need Istanbul, the older people appreciate the for purpose-built bathrooms and toilets for good water supply. older people is reported. In New Delhi, it is 3. Design considered that kitchens need to be better designed. In Mexico City, the need to have Several aspects of housing design are con- railings and elevators in multi-level build- sidered to aff ect the ability of older people ings is mentioned, and people in Tokyo to live comfortably at home. In general, it point out the need for passages and door- is considered important for older people to ways to accommodate wheelchairs. live in accommodation that is built from adequate materials and structurally sound; 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 31 In many cities, there is recognition of the A number of diffi culties are identifi ed in measures that have been taken to improve relation to home modifi cations. In Halifax, housing design to accommodate older retrofi tting a home is considered to be ex- people. In Mexico City, for example, 1% of pensive and diffi cult. Restrictions on the re- all houses built must be suitable for older modelling of public housing are mentioned people. In Halifax, some condominiums in Himeji and New Delhi. In Portland, are age-friendly and have access ramps, rented accommodation that has been elevators, parking, gym facilities and wide remodelled is required to be returned to its doorways. original state. In Melbourne, it is pointed out that assistance equipment is not used Nevertheless, people frequently feel that because it does not fi t into the home and more needs to be done to ensure housing many caregivers are unable to aff ord the is appropriate for older people. In Himeji, necessary renovations. In Sherbrooke, the more age-friendly housing is recom- need to adapt housing for specifi c condi- mended, while in Melbourne, incentives to tions is mentioned. encourage architects and property develop- ers to build age-friendly housing are sug- Besides identifying the need to ensure older gested. People in New Delhi recommend people are aware of the possible options that age-friendly features be incorporated for modifying their homes, it is suggested into building by-laws. In Saanich, builders in many cities that older people need to include adapted or adaptable features into be able to obtain the necessary equip- their plans, such as lower placement of light ment. In Tuymazy, caregivers identify their switches, installation of showers rather need for information on diff erent types of than bathtubs, and stairways that can be equipment and possible adaptations and converted to accommodate a chairlift. on equipment that is easy to obtain. In Udaipur, diffi culties in obtaining hand rails, 4. Modifi cations ramps and toilets are mentioned. Th e ability to modify one’s house or 5. Maintenance apartment also aff ects the ability of older people to continue to live comfortably at Being unable to maintain one’s home is as home. Caregivers in Dundalk appreciate a major barrier for some older people. In the chairlifts that were installed to assist Cancún, older people say they are unable older people. In Mayaguez, apartments for to make repairs owing to the cost involved. disabled older people have the adaptations In Melbourne, they are likewise concerned required. In a small number of cities, such about costs of maintenance and suggest as Himeji and Dundalk, fi nancial assistance that the local municipality provide a home is provided for home modifi cations. maintenance service for a nominal fee. In Rio de Janeiro, the high cost of condomin- ium maintenance fees is considered to be a

PAGE 32 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

barrier, although it is pointed out that it is mentioned the importance of the concierge possible to sublet condominiums to assist in establishing contact among residents and with the cost of the maintenance fees. taking care of repairs.

In Dundalk, the older people value the 6. Access to services grants provided for home repairs but com- Th e provision of services to older people plain about diffi culties in organizing the in their homes is particularly important. service people to undertake the repairs. In Udine, it is stated that older people do not consider moving house. In Tuymazy, Went away in the middle of it and didn’t come back for months to fi nish it. the service providers similarly indicate that older people are very attached to Older person, Dundalk their homes and do not want to move. In Saanich, receiving home assistance is con- In Melville, concern is raised about hav- sidered preferable to moving house. ing strangers coming into the home to do maintenance work, and it is suggested that In a few cities, diffi culty in obtaining the local municipality maintain a list of de- services at home, including their cost, is pendable repair services that are prepared considered a disadvantage. In the Ruhr to deal with older people. In Portland, metropolitan region, services such as clean- caregivers appreciate the system used for ing and gardening are seen to be scarce and screening contractors and other repair and expensive. Older people in Saanich report maintenance services. that there are not enough cleaning and gardening services available. Problems are also identifi ed regarding the maintenance provided in public housing Living close to services and facilities is also and rented accommodation. In London, seen as an age-friendly feature. Th is is more concern is raised about repairs not being commonly mentioned by people in cities done in a timely manner. In Tripoli, older in developed countries, such as Melville, people indicate that landlords purposely Portage La Prairie and Tokyo. In San José, neglect maintenance so that the older older people valued living in close proximity people leave. In Delhi, it is reported that to public, commercial and religious ser- common areas like staircases are often vices. In a number of cities, such as Nairobi, neglected, dirty and dark. Udaipur and Udine, not living in close proximity to such services is seen as a problem. Nevertheless, staff in collective dwellings, such as concierges and caretakers, sometimes play an important role in ensuring well-being. In Geneva, the older people

PAGE 33 Nevertheless, caution is also expressed the lack of contact with younger people in about remaining at home and being unable apartment buildings is seen as a disadvan- to look after oneself adequately. In Mexico tage. In Udaipur, caregivers are concerned City, the need to educate older people about that modern ﬂ ats without front verandas the risks of living at home is raised, and in leave no room for community interaction. Saanich, the idea is advanced on provid- Th e importance of design that facilitates ing information on home services for older community interaction is mentioned in people by publishing a directory of home Dundalk as well, where it is suggested that support services houses should overlook communal facilities to reduce the sense of isolation. 7. Community and family connections 8. Housing options Familiar surroundings, whereby people feel A range of housing options in the local area part of the local community, contribute to accommodate changing needs is regard- to the age-friendliness of a city. For this ed as an important age-friendly feature. reason, older people are reluctant to move. In some cities, there are a number of such In Udine, older people mention they have housing options. In Melville, for example, a kind of “psychological safety” in their older people have the choice of moving into environment. In Tripoli, older people high- smaller accommodation, seniors’ housing light the importance of their neighbours. In or care facilities. In many locations, how- Dundalk, service providers recognize the ever, the need for more housing options need to locate new homes close to where for older people is stressed. In Halifax, for older people have lived in order to retain example, it was mentioned that some older links with family and the community. In people were concerned about not being able Himeji, concern is expressed that older to ﬁ nd accommodation in their local area people lose their connection with the com- and did not have good knowledge about the munity when they move to another facility. housing options in their area.

Changes to the city aﬀ ect these feelings of In some cities, dedicated seniors’ housing familiarity with the community. In Tokyo, options are provided. In Melville, seniors’ the lack of personal contact with neigh- housing complexes provide a range of ser- bours that results from the development of vices, amenities and activities. high-rise buildings is regarded as an age- friendly barrier. In Sherbrooke, older people You've got a lot of social activities, you can express concern about the lack of multigen- be busy the whole time or you can just close erational spaces for interaction. In Geneva, your door and not join in, it's your choice. Older person, Melville

PAGE 34 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Dedicated seniors’ housing seems to be in Feeling safe in the home environment is short supply in many cities and waiting another theme. In many cities, older people times can be long, as mentioned in Halifax feel insecure and particularly fear living and Himeji. Seniors’ housing also needs alone. Measures have been taken in some to be aff ordable to be age-friendly. Older cities to improve the security in older people in Saanich express concern about people’s homes. In Dundalk, for example, the cost of seniors’ housing. Th ere is also a surveillance cameras are used in some clearly expressed preference in a few cities homes; in Geneva, there is secure access for seniors’ housing to be integrated into to apartment buildings; in Saanich, older the local community. In Melville, it is sug- people are provided with free home secu- gested that small clusters of seniors’ hous- rity checks; and in Shanghai, there is a local ing with small gardens be made available security patrol. In Himeji, some apartments throughout the city, so that older people have emergency call monitoring devices to are not isolated from the community and keep older people safe. particularly from children. In Portland, Nevertheless, there is an expressed need for the need for multigenerational housing is more to be done to ensure that older people identifi ed. In the Ruhr metropolitan region feel secure at home. In Udaipur, more and Sherbrooke, concern is expressed about information about home security is recom- creating ghettos of older people in large mended, and in Saanich, it is suggested that seniors’ housing complexes. emergency alarms be installed. 9. Living environment In some cities, the homes of older people It is important for older people to have are not located in environments that are suffi cient space and privacy at home. safe from natural disasters. In La Plata, In a handful of developing cities and in some homes are in fl ood-prone areas, and Tuymazy, overcrowding is identifi ed as a in Islamabad, older people are concerned barrier for older people. In Delhi, for exam- about earthquakes. ple, 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.

PAGE 35 Age-friendly housing checklist

Aff ordability Modifi cations • Aff ordable housing is available for all • Housing is modifi ed for older people as older people. needed. Essential services • Housing modifi cations are aff ordable. • Essential services are provided that are • Equipment for housing modifi cations is aff ordable to all. readily available. Design • Financial assistance is provided for home modifi cations. • Housing is made of appropriate materials and well-structured. • Th ere is a good understanding of how housing can be modifi ed to meet the • Th ere is suffi cient space to enable older needs of older people. people to move around freely. Maintenance • Housing is appropriately equipped to meet environmental conditions (e.g. ap- • Maintenance services are aff ordable for propriate air-conditioning or heating). older people. • Housing is adapted for older people, with • Th ere are appropriately qualifi ed and even surfaces, passages wide enough for reliable service providers to undertake wheelchairs, and appropriately designed maintenance work. bathrooms, toilets and kitchens. • Public housing, rented accommodation and common areas are well-maintained.

PAGE 36 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Ageing in place • Suffi cient and aff ordable housing dedicated to older people is provided in the local • Housing is located close to services and area. facilities. • Th ere is a range of appropriate services • Aff ordable services are provided to en- and appropriate amenities and activities able older people to remain at home, to in older people’s housing facilities. “age in place”. • Older people’s housing is integrated in • Older people are well-informed of the the surrounding community. services available to help them age in place. Living environment Community integration • Housing is not overcrowded. • Housing design facilitates continued • Older people are comfortable in their integration of older people into the com- housing environment. munity. • Housing is not located in areas prone to Housing options natural disasters. • A range of appropriate and aff ordable • Older people feel safe in the environment housing options is available for older they live in. people, including frail and disabled older • Financial assistance is provided for hous- people, in the local area. ing security measures. • Older people are well-informed of the available housing options.

PAGE 37 Part 8. Social participation

Overview of fi ndings mobility issues, is important everywhere, and even more so in developing countries Social participation and social support and those with economies in transition. are strongly connected to good health and well-being throughout life. Participating in 1. Accessible opportunities leisure, social, cultural and spiritual activi- Older people may be aware of events and ties in the community, as well as with the activities that exist in their community, but family, allows older people to continue to in the experience of many participants in exercise their competence, to enjoy respect the project these activities are inaccessible. and esteem, and to maintain or establish Personal safety, particularly at night, is supportive and caring relationships. It mentioned as one barrier in both developed fosters social integration and is the key and developing cities, including Halifax, to staying informed. Yet the older people La Plata, London and Rio de Janeiro. In consulted by WHO indicate clearly that the many cities, the locations are too distant capacity to participate in formal and infor- and transportation is diffi cult. Another mal social life depends not only on the off er common problem is the accessibility of the of activities, but also on having adequate buildings, especially for people with im- access to transportation and facilities and paired mobility, and the lack of adequate on getting information about activities. facilities such as toilets, appropriate seating When I see my group colleagues, I feel very or smoke-free air. Another barrier men- well. tioned is restricted admission, such as the requirement to be a member of an organi- Older person, Mexico City zation.

In most cities, older people report that they They [older people with disabilities] fi nd participate actively in their communities it diffi cult to adjust as there are no proper but feel there could be more possibilities arrangements for their sitting, toilet, etc. for participation. Th ey suggest having more Recreation for most of them would be talk- and varied activities closer to where they ing to their friends or relatives on the phone or occasional visits. live. Th ey would like activities that foster integration within the community and with Caregiver, New Delhi other age groups and cultures. Th e biggest concerns are aff ordability and accessibility, Eff orts in several cities to accommodate especially for people with disabilities, and older people are recognized by the older awareness of activities and events. Having people themselves and those who interact appropriate support in place to enable accessibility, particularly for people with

PAGE 38 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

with them. Th e municipal government in fewer opportunities exist for people who Mayaguez reportedly organizes a variety of live outside those centres. Th ere may also activities at hours that are suitable for older be fewer options for people who are frail people and provides transportation. An or disabled. Sometimes the schedules of older person in Geneva notes that ameni- activities are rigid and older people need ties are provided for people who are hard to make a choice between meeting their of hearing. Th e availability of community personal needs, such as a regular nap in the transport is reported from both Melbourne afternoon, and participating in an activ- and Melville, conveniently located activi- ity. Locations where activities do occur ties from Portland, and convenient tim- may not appeal to older people because of ing of events and activities from Tripoli. noise levels or an emphasis on youth pro- Participants in Dundalk suggest that allow- grammes. A variety of both targeted and ing older people to bring a friend to events integrated activities provides a broad and would help them participate. diverse range of choice for more people. Th e range can include organized events 2. Aff ordable activities such as those in Himeiji, which are tar- Activities that are free or at least af- geted to people over 80. In Jamaica, older fordable facilitate participation by older people mention sporting events in which adults. Th e cost of activities is a frequently older people can compete at various levels. mentioned problem, especially in cities Portage La Prairie off ers communal meals in developing countries and those with and social contact as part of the attrac- economies in transition. In some areas, tion. Outdoor activities, such as a walk in a a variety of options exist only for people garden in Nairobi and a fi ne-weather stroll with adequate incomes, and recreation in Moscow, are seen as simple and low cost and leisure activities are only available to ways of encouraging social participation the rich. Participants in Islamabad note, It is reported from Udine that buildings are however, that participation in activities is off ered to older people for activities such aff ordable. Rio de Janeiro off ers many free as theatre, clubs, and Th ird Age University. leisure activities, and Mexico City has free In Tuymazy, there is a chess club, a histori- or low-cost cultural events. In Dundalk, cal re-enactment society and a club for the Geneva and London, it is mentioned that over-60s. Participants from Cancún say because of high insurance costs, non-profi t they enjoy a “golden age” club, craft classes organizations are obliged to charge prices at the local monastery, and talks, music and for activities that they know may discour- dancing. All of the larger cities in the devel- age participation. oped regions, and the majority of cities in 3. Range of opportunities the developing countries, are said to off er a variety of activities. 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

PAGE 39 Religious activities and socializing within I think where it falls down is on awareness faith communities is an important form – people knowing about what options are of participation for older people in most of out there. the cities. Older people may be well-known and esteemed within their local faith com- Service provider, Saanich munity. Th ese communities are usually welcoming and inclusive too, facilitating In Dundalk, it is reported that organiza- participation by people who may be at risk tions promote their activities by sending in- of becoming isolated. It is reported from formation to older people before they retire. Halifax, for example, that churches contrib- People who attend religious services and ute to older people’s lives through activities other scheduled activities regularly tend to such as card games, group meals, drives to hear about other activities through word of church, and outreach to isolated people. In mouth. In San José, occupational associa- Islamabad, it is noted that going to mosque tions promote their activities. A service more than once a day contributes to social provider in Shanghai suggests more older participation. people can be engaged if there is enough publicity to attract participants. At church we are listened to because of our experience. People look up to us. 5. Encouraging participation and addressing isolation Older person, Jamaica A consistent message from cities around the world is that social participation is Cultural, educational and traditional activi- easier when the opportunities are close to ties also remain important to older people home and there are many of them. People in many locations. Continuing education in La Plata are dissatisﬁ ed with the lack through Th ird Age Universities or through of community centres in all neighbour- courses at local community or seniors’ hoods, and in Udaipur, it is suggested that centres provides ongoing engagement and community centres be provided within learning. Going to weddings and funerals distances that are walkable for older people. are opportunities to socialize. Older people Participants in Dundalk and Shanghai in Islamabad report enjoying frequent tra- advise using facilities in the community, ditional events such as weddings. such as schools and recreation centres, 4. Awareness of activities and events for all community members, including older people. Th is suggestion is echoed in Several participants point out that older Islamabad: a greater variety of leisure time people need to know about activities and activities in more locations. opportunities in order to participate.

PAGE 40 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Concerted eff orts to encourage and mo- I think there are lots of opportunities if tivate older people to participate can people are connected and have someone to sometimes make the diff erence between go with, but I think we can hear from the participation and isolation. Many people lonely people and the marginalized through who are involved with groups and clubs for organizations to rebuild social networks or older people are very satisfi ed with their make some connections. activities. However, some people express Service provider, Halifax reluctance to join associations and clubs for a variety of reasons: they may not know Caregivers, many of whom are older people anyone, they may feel that they have to as- themselves, are particularly vulnerable to sociate with a particular political view, or feeling isolated because their world is so they fi nd that the activities of that club are centred on the person for whom they care. not appealing. Participants suggest more programmes and options whereby older people with disabili- Older people are reluctant to do anything. Many were asked to join the club and ties can socialize outside the home without refused. requiring the presence of their caregiver. Provision of day programmes and respite Service provider, Himeji options are suggested as ways of helping older caregivers and their charges to con- Various reasons are given to explain why tinue to connect with society. isolated older people fi nd it more diffi cult to associate with others. Th eir social con- Few men participate; they do not accept tacts have become eroded after the death their age and/or they feel uncomfortable sur- of their spouse and then gradually other rounded by so many women. family members and friends. Th eir health Older person, Cancún may be declining, limiting their ability to participate. Owing to societal changes, Th e lack of social participation by men is more women are in the workforce and raised in several cities, including Cancún are therefore not at home during the day and Geneva. In some cities, nevertheless, to visit older people. Outreach to isolated there are activities intended to appeal to older people in their homes provides a men: in Melville, for example, there is a social connection and a way of encouraging “Men’s Shed” off ering activities for men of them to participate. In both Melbourne and various ages. Older people in Istanbul men- Shanghai, it is reported that organizations tion that mosques are good places for men take the initiative to seek out older people to participate in society. Participants in and invite them to activities. Mexico City suggest more activities specifi - cally for men, such as workshops or playing dominos or cards.

PAGE 41 Some older people choose not to participate, If older people are unable to participate in and respect for those who prefer to disen- activities outside of their homes, watching gage is advised by participants in Portland. television remains their only source of leisure and connection with society. Th e need 6. Integrating generations, cultures to integrate options for all generations and and communities ages is reﬂ ected in the concerns of older Older people want opportunities to social- people in some cities about the poor range ize and integrate with other age groups and of programming choices available on televi- cultures in their communities, activities sion, with little that appeals to them. and families. TV viewing is one option, but the kinds of Older people feel they can participate in programmes that are being dished out these different areas and with people of all ages, days on TV are not meant for family audi- depending on the personal initiative and ences. desire. Older person, Udaipur La Plata, Argentina Older people in many areas want to partici- Intergenerational activities are considered pate in their families in a meaningful way. to be more desirable than activities for In Amman, for example, older people state older people alone. Th ese opportunities can that they do not want to be isolated from be provided by sharing spaces and facili- their families. However, families may not ties, such as in Saanich, where a seniors’ give enough consideration to older people, centre is located in an unused part of an especially if there are expectations for elementary school. In Ponce, some activi- grandparents to care for grandchildren or ties involve older people in school settings. if there is little time to devote to activities Programmes provided at community and with or for an older family member. recreation centres are suggested for encour- Better integration of generations is seen as aging participation by people of diﬀ erent a way to counter ageism in society, which ages and levels of ability. 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 42 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Intergenerational opportunities enrich the An open and welcoming neighbourhood experience for all ages. Older people pass in the Ruhr metropolitan region pro- on traditional practices and knowledge and vides a basis for newcomers to integrate. experiences, while younger people oﬀ er Newcomers in cities around the world are information about newer practices and help at risk of becoming isolated, and older older people navigate in a rapidly chang- people in this project recognize the need ing society. Older people in Nairobi are to better integrate their activities to en- engaged in traditional dances and skills, courage more participation by people from enabling them to pass that knowledge to other places and cultures. others. I wish there were a way to foster more mul- [Older people] are a source of “lived tradi- ticultural community activities in neighbour- tion”. hoods where there’s a diverse population.

Caregiver, Nairobi Older person, Portland

Th e constitution and design of a neigh- The solution must be for older residents to bourhood can encourage the integration of strive to accept new residents as their com- people from various backgrounds, ages and panions. Also, it will be good for neighbours cultures. Many neighbourhoods in cities to exchange greetings among themselves. around the world are changing. Younger Older person, Tokyo 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.

Villages became empty. They moved to the cities. Now the villagers become older in cities.

Older person, Istanbul

PAGE 43 Age-friendly social participation checklist

Accessibility of events and activities recreation centres, schools, libraries, community centres in residential neighbour- • Th e location is convenient to older people in hoods, parks and gardens. their neighbourhoods, with aff ordable, fl exible transportation. • Facilities are accessible and equipped to enable participation by people with disabilities • Older people have the option of participat- or by those who require care. ing with a friend or caregiver. • Times of events are convenient for older Promotion and awareness of activities people during the day. • Activities and events are well-communi- • Admission to an event is open (e.g. no cated to older people, including informa- membership required) and admission, such tion about the activity, its accessibility and as ticket purchasing, is a quick, one-stop transportation options. process that does not require older people to Addressing isolation queue for a long time. • Personal invitations are sent to promote Aff ordability activities and encourage participation. • Events and activities and local attractions • Events are easy to attend, and no special are aff ordable for older participants, with no skills (including literacy) are required. hidden or additional costs (such as transpor- • A club member who no longer attends tation costs). activities is kept on the club’s mailing and • Voluntary organizations are supported by telephone lists unless the member asks to be the public and private sectors to keep the taken off . costs of activities for older people aff ordable. • Organizations make eff orts to engage iso- Range of events and activities lated seniors through, for example, personal visits or telephone calls. • A wide variety of activities is available to appeal to a diverse population of older people, Fostering community integration each of whom has many potential interests. • Community facilities promote shared and • Community activities encourage the partici- multipurpose use by people of diff erent ages pation of people of diff erent ages and cul- and interests and foster interaction among tural backgrounds user groups. Facilities and settings • Local gathering places and activities promote familiarity and exchange among • Gatherings, including older people, occur neighbourhood residents. in a variety of community locations, such as

PAGE 44 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Part 9. Respect and social inclusion

Overview of ﬁ ndings You walk down the street and people smile Older people report experiencing conﬂ ict- at you, you go into a shop and you’re served, ing types of behaviour and attitudes towards the kids even say hello to you even if they them. On the one hand, many feel they are don’t know you. often respected, recognized and included, Older person, Melbourne while on the other, they experience lack of consideration in the community, in services In Jamaica and in Ponce, for example, and in the family. Th is clash is explained in older people feel they are given priority terms of a changing society and behavioural service in businesses and public places. norms, lack of contact between generations, In Islamabad and Moscow, it is said that and widespread ignorance about ageing and people give up their seats on buses to older older people. It is clear from the consulta- adults. Examples of age-friendly services tion that the respect and social inclusion of are mentioned in some cities: in Portage older people depend on more than societal la Prairie, ballot papers are taken to the change: factors such as culture, gender, homes of older people who are unable to go health status and economic status play a to polling stations, and headsets are pro- large role. Th e extent to which older people vided in churches for people with hearing participate in the social, civic and economic impairments. In Mexico City, there is men- life of the city is also closely linked to their tion of a bank whose employees are trained experience of inclusion. to treat older people well, and at the end 1. Respectful and disrespectful of each month time is reserved exclusively behaviour to serve older people. It is also reported that in some businesses in Jamaica, older Project participants primarily comment on people can sit and wait to be served directly the behaviour of people towards them that by employees assigned to the sitting areas. shows respect and courtesy, or the oppo- Also, in Tokyo, older people note that busi- site. As a whole, older people are respected nesses treat them well because most cus- in the cities that have been studied: most tomers are older. In addition, older people of the older people and other participants feel particularly respected and included in in the focus groups recall the respect and seniors’ clubs. It is also noted that when kindness expressed in everyday life towards older people themselves are respectful older adults. and pleasant, they often receive the same response from others.

PAGE 45 Nevertheless, participants in several cit- Some old people keep going from one ofﬁ ce ies also report disrespectful behaviour to another without getting the information towards older people. People are seen to they are looking for because nobody takes be impatient with older people who are time and has the courtesy to listen to them. slower doing things, and rude gestures are made towards older drivers. In Sherbrooke, Service provider, Mayaguez they feel they are treated like children. Older adults in Amman also feel they are Suggestions for promoting age-friendly criticized by young people for their dif- services focus on training service providers ferent clothes and way of talking. Some to understand how they can better respond young people are said to lack good man- to the needs of older people. ners (Tokyo and Udine), not to give up their 2. Ageism and ignorance seats on buses (Portland) and to be verbally or physically aggressive towards older In a society that gloriﬁ es youth and change people (Halifax, New Delhi and San José). in its popular imagery, the common negative images of age and ageing are often They look at you as if your “use-by” date has evoked to explain disrespectful behaviour. passed and they don’t want to serve you. Among the ageist biases reported, older people are considered to be useless, less Older person, Melville intelligent, stingy and a burden. As a group, there is a perception in developed coun- Commercial and professional services are tries that they are demanding and a drain also said to be disrespectful or inconsider- on public resources. Older people who are ate of older people’s needs in some cities. ill or who have disabilities are more likely A caregiver in Amman noted that food in than those who are healthy to be viewed restaurants is not suitable for older people. negatively. Poor service in shops is noted in Melville. In La Plata and Mayaguez, banks clerks You are far more respected if you are healthy and employees in public agencies are said and not dependent on anyone, even by your to not listen to the needs and complaints own child. of older people. In San José, the example is given of doctors having their prescriptions Older person, Tripoli prepared even before seeing older patients. Other concerns about service providers are Disrespectful behaviour and ageism are expressed in, for instance, Nairobi, Ponce believed to result from ignorance of good and Saanich. manners in some cities, the impersonal- ity of large and growing cities, the lack of interaction between generations, and the general lack of public knowledge about

PAGE 46 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

ageing and older people. In Melbourne and What you run into is the attitude towards New Delhi, it is also recognized that there seniors that needs to be readjusted. I ﬁ nd is a gap between contemporary norms of that’s the biggest problem, and I don’t know individualism and the expectations of older how to educate younger people to respect people. seniors.

3. Intergenerational interactions Older person, Portage la Prairie and public education Many express the opinion that community There is a big disadvantage today … kids education should begin in primary school, don’t have that privilege, getting to be with so that people learn cultural values and old people … it pays an awful price. to appreciate older people. In the view of Older person, Portland participants, education about ageing should include acquiring some understanding of In nearly all the cities in the project, par- the diffi culties caused by physical aging and ticipants underlined the great need to common impairments. As stated in Jamaica, facilitate and organize encounters between people would be able to prepare themselves the generations, such as: working together; for that period of life by means of such edu- participating in intergenerational planned cation. Almost all of the focus groups insist events; older people participating in civic on the importance of inculcating respect or historical education at school, or taking for older adults; in Udaipur, summer camps care of children in public spaces; and young concentrating on social values are sug- people helping of old people on a voluntary gested as a way to do this. Education about basis. Every solution that promotes inter- ageing through age-friendly advertising in generational activities is welcomed in most the media is proposed as well; examples are cities. In Geneva, older people mention that given in Melville of a television programme they themselves should take the fi rst step in showing a young person relating to an older meeting the younger generation. person, or of newspapers writing profi les of local older people who have done a lot for A common view is that public awareness the community. Advertisements and posters about ageing and its issues is greatly lack- with attractive depictions of ageing are also ing, and that education about ageing should mentioned, as well as presentations of older begin early and extend to all groups in people in realistic and non-caricatured ways. society.

PAGE 47 4. Place within the community We rely on … the elderly as volunteers and we certainly value their opinion and their We don’t listen to the voices of the elderly in input. our societies. Service provider, Saanich Caregiver, Sherbrooke

Older adults are sometimes on committees Th e role that older people play in the commu- and boards of associations and organiza- nity contributes to the respect and inclusion tions, although in Sherbrooke it is said that they enjoy. In a few cities, such as Moscow and they still need to be better represented in Tokyo, it is reported that they still maintain an these areas. A point that is often raised is active local leadership role and have an impact that older people, their capacities and their on public decisions. More often, however, par- life experience have to be trusted and used ticipants talk about the loss of these leadership in decision-making. Th eir resources have to responsibilities, and even reluctance to listen be valued by the community, as suggested to advice from older people, as reported in in Dundalk and Mexico City. Service pro- Melville. In Mayaguez, participants note that viders in Portland add that older people can the community is no longer used to taking be important eyes and ears of a community. older people’s opinions into account, and now even decisions concerning older people are 5. Helpfulness of the community taken without consulting them. You know, people know one another, it’s not Social engagement by older people positively a big city. And this is it, when you know one contributes to their esteem in the community. another, you help one another. Older people seem to be very often involved in volunteer services, in which they may play Older person, Portage la Prairie an active role, as in Halifax and Melbourne. Some jobs are reserved for older people, such Many comments concern the helpfulness as in the supermarkets in Cancún. In Himeji, of people in the city towards older people a programme called “Ask Older People” is and the reasons why communities are more cited as an example of age-friendly inclu- or less inclusive. Smaller communities, sion: this programme involves older people in where people have lived for a long time and activities in which they have experience, such know each other, are seen to be friendlier as gardening, organizing events or talking at and more inclusive: examples are Dundalk, elementary schools. In Saanich, programmes Portage la Prairie and the Copacabana dis- that connect older people with schools are trict of Rio de Janeiro. reported. People would notice if you weren’t at mass.

Older person, Dundalk

PAGE 48 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

In other, larger cities, comments are made gradually marginalized in their own fami- to the eff ect that the city is “too big” and lies. In Islamabad, older people report that impersonal, as in Istanbul. Neighbourhoods older women are not always consulted in are seen to not be cohesive in Islamabad family matters. In New Delhi, grandparents and Mexico City, and in London, the neigh- are said to become reduced to the state of bours seem to change so quickly that people servants of their grandchildren. In San José, no longer have the time to meet and get to some families even require the grandpar- know one another. Nevertheless, more inclu- ents to work for money. Service providers in sive communities can be fostered. Some of a few cities mention problems of abandon- the focus groups propose promoting better ment or abuse of older people. organized neighbourhoods with, for example, local street committees (San José and 7. Economic exclusion Tuymazy). Th e creation of places for neigh- I’m feeling intimidated when I am in a store bourhood meetings is suggested in Istanbul; because I cannot afford to buy what I need. this is reported to be already in place in La Plata, where a part of the city hall is desig- Older person, Tuymazy nated for older people’s meetings. In several countries, the majority of older 6. Place in the family people have rather low incomes, and In some cities, such as Amman and poverty at any age excludes people from so- Udaipur, it is considered an advantage ciety. In the Russian Federation, many older for older people to live with their family. people report that they feel excluded from Remaining with the family signifi es being the society because of their low income: cared for, having aff ection and maintain- retired people fully depend on the small ing social status in the view of people government allowances. It is reported in from Tripoli. In Udaipur, older people are Jamaica and Mexico City that people often not only consulted by their families when get very little personal fi nancial aid from decisions are made, but their views are the government, and that there is too much accepted. Some older people mention that bureaucracy involved in obtaining entitle- they have left their community of origin to ments. In Cancún, older people say that go and live with their children in Cancún. they do not feel included in government Family members are said to be helpful programmes. and supportive, but at the same time it is noted that family relationships are chang- For the fi rst time, somebody thought about ing. Comments are made, for instance in the needs of those who don’t have any income [about the “Si Vale card”]. Istanbul and New Delhi, that families are more scattered because children move Older person, Mexico City away, and that younger generations do not have much time to spend with older family In Mexico City, people highly appreci- members. As a consequence, it is reported from New Delhi that older people are

PAGE 49 ate the economic support adapted to the to lower prices and even free services, and a economic condition of older people. Th is “Si Vale card” guaranteeing the poorest an includes an ID card allowing them access income of US$ 80 per month.

Age-friendly respect and social inclusion checklist

Respectful and inclusive services Public education • Older people are consulted by public, vol- • Learning about ageing and older people untary and commercial services on ways is included in primary and secondary to serve them better. school curricula. • Public and commercial services provide • Older people are actively and regularly services and products adapted to older involved in local school activities with people’s needs and preferences. children and teachers. • Services have helpful and courteous staff • Older people are provided opportunities trained to respond to older people. to share their knowledge, history and expertise with other generations. Public images of ageing Community inclusion • Th e media include older people in public imagery, depicting them positively and • Older people are included as full partners without stereotypes. in community decision-making aff ecting them. Intergenerational and family interactions • Older people are recognized by the community for their past as well as their pres- • Community-wide settings, activities ent contributions. and events attract people of all ages by accommodating age-specifi c needs and • Community action to strengthen neigh- preferences. bourhood ties and support include older residents as key informants, advisers, • Older people are specifi cally included in actors and benefi ciaries. community activities for “families”. • Activities that bring generations together Economic inclusion for mutual enjoyment and enrichment • Economically disadvantaged older people are regularly held. enjoy access to public, voluntary and private services and events.

PAGE 50 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Part 10. Civic participation and employment

Overview of fi ndings 1. Volunteering options for older people Older people do not stop contributing to their communities on retirement. Many It’s been scientifi cally proven that volunteer- continue to provide unpaid and voluntary ing can help you stay healthy and live longer. work for their families and communities. In some areas, economic circumstances force Older person, Halifax older people to take paid work long after they should have retired. An age-friendly In many of the participating cities, older community provides options for older people are very actively involved in vol- people to continue to contribute to their untary activities and enjoy many benefi ts communities, through paid employment or from volunteering, including a sense of self voluntary work if they so choose, and to be worth, of feeling active, and of maintain- engaged in the political process. ing their health and social connections. Participants in some cities report that there Many older people would like to continue is a well-developed volunteer infrastruc- working and some, in fact, do so. In ad- ture, such as volunteer resource centres or dition, older people participating in the well-established voluntary organizations. In WHO project expressed a desire and a most cities, participants say there are many willingness to work as a volunteer in their opportunities to volunteer. communities. Older people in most cities have access to employment and volunteer In Ponce, older people like feeling useful opportunities and in general feel respected through volunteering, and in Udine it is for their contributions. Older people would noted that voluntary work is rewarding and like to have more opportunities for em- prevents isolation. Older people in Geneva ployment, and would like to see current volunteer within clubs and organizations. 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.

PAGE 51 Despite the importance of volunteering, Several participants mention a general participants note many barriers for older decline or change in the voluntary sector people, such as fi nding out about volun- that aff ects older volunteers. Th is includes teer opportunities, particularly those that a feeling that the ethic of volunteering is would be most suited to them. Participants diminishing and that younger people are want more opportunities and a greater failing to replace older people. In Halifax, range of options. Creating central registers an older person considers that increasing is suggested as a way to address this. In paperwork and insurance costs are contrib- Melbourne, there is a project under way uting to the decline in the body of volun- to use the Internet to match volunteers to teers. In Dundalk, it is suggested that insur- opportunities, and a site that lists volunteer ance costs be waived for older volunteers. opportunities exists in Portland. Older Suggestions for improving volunteering residents in Melville and Udaipur suggest call for strengthening voluntary organiza- creating a central database or register of tions generally, establishing elderly volun- volunteers, and participants in New Delhi teer corps, and reimbursing volunteers for suggest this could be run by an organiza- expenses related to their work. Participants tion such as HelpAge India. . in Islamabad call for establishing a volun- In addition, older people face problems get- teer corps of older people to work with the ting to and from voluntary jobs, and some disadvantaged. In Mayaguez, incentives for report physical limitations in completing older volunteers are suggested, and a ser- the tasks assigned to them. In more devel- vice provider in Mexico City recommends oped countries, some older people and ser- that volunteers should be reimbursed for vice providers report that un-reimbursed their expenses. In Himeji, fi nancial support expenses (such as for petrol) or liability for voluntary organizations is suggested. issues (on the part of the voluntary organi- In Shanghai, it is felt that a rewarding zations) impede their ability or willingness and supportive social atmosphere would to volunteer. encourage more people to volunteer. In Tokyo, invitations are suggested as a way to encourage older people to volunteer.

PAGE 52 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

2. Better employment options and families by caring for grandchildren, and in more opportunities Mexico City it is felt that doing this kind of work prevents older people from obtaining My mother often talks about working, but proper employment. I know she can’t manage. It’s just that they like their own money. In places of low income and limited government support, some older people feel that Caregiver, Jamaica they need to work whether they want to or not. In some cities (e.g. Moscow, Nairobi We need to assist the old people to remain and Ponce), focus group participants com- employed. To work is a gift of health and of ment that the general level of unemploy- life. ment and competition for jobs aﬀ ect their ability to ﬁ nd work. Service provider, Tripoli

I cannot think of working. Why? Because you Participants in many cities report that they know, unemployment is high even in youth, are eager and willing to work and have so how can I want to work? the experience and qualifi cations to work. However, older people face a variety of bar- Older person, Istanbul riers in fi nding work or staying employed. Policies that make retirement mandatory by Despite these barriers, older people are still a certain arbitrary age, which varies among working in a number of cities. Older people countries, are rejected by focus group in Tripoli note many benefi ts of continu- participants. Some countries have policies ing to work, including income, combating whereby any money earned after the “re- attitudes that older people are dependent, tirement” age is deducted from government and continued social connections. Many income support programmes or pensions, older people in Himeji are willing to work, thus creating another barrier for older and would like to see more opportunities people who want to continue working. for employment. Older people in Amman suggest that the time and experience of In several places, older people report that older people should be used as long as they they are simply too frail to work, have are able to work, and that incentives be diffi culty getting to and from work, or do provided to encourage participation. 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

PAGE 53 A few places, largely in developed coun- Th ere were also a number of suggestions tries, do have policies, and some mention for improving the type or conditions of specifi c companies that promote and value work. In some places, respondents feel that older workers. In Mayaguez, service pro- the problem was not having the informa- viders note that there is little absenteeism tion and tools to match the skills and needs among older workers, and they also tend to of older workers with those of employers. be punctual. In Melville, it is felt that work- Suggestions to remedy the situation include places are changing and that there is a more better advertising of positions, creating positive attitude to retaining older workers. databases to match older worker with jobs, and developing a register listing older peo- Participants have a number of sugges- ple’s skills for potential employers to con- tions for how to improve and create new sult. In Istanbul, it is felt there should be opportunities for employment for older more support for women working at home, people. Th ese include off ering incentives and in New Delhi, sensitizing employers to to employers who hire older people, having the needs of older people is suggested. government-sponsored employment programmes, creating public/private partner- 3. Flexibility to accommodate older ships, and hiring older people to do public workers and volunteers sector jobs. I don’t want something I have to be there Eliminating mandatory retirement, or age every week at 9:00; I got enough of that restrictions for employment, is suggested working. in the places where such legislation ex- Older person, Portland ists. Allowing people to work beyond the retirement age is suggested in Dundalk, and Flexibility in opportunities for older people eliminating the legal age restriction for em- in paid and voluntary work is cited as a way ployment is proposed in Islamabad. Service to better tailor such opportunities to older providers in Sherbrooke feel there should people. be greater fl exibility in legislation and policies to enable retired people to return to Th ere are reports of rigid schedules, and a work. One older person in Istanbul suggests feeling that voluntary jobs have become too banning early retirement. 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 54 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Older people in Geneva feel that voluntary Despite these reports of civic engage- opportunities should be fl exible and match ment, a signifi cant proportion of cities also the ability of those volunteering, taking report that opportunities for older people into account the needs of older people who to engage in civic aff airs are limited. Some may tire more quickly. Service providers cities mention logistical barriers, such as in Himeji feel that corporations should de- lack of transportation to civic functions, velop an environment whereby older people lack of physical accommodation, and safety can work without diffi culty, and many cor- concerns at large civic events. porations have this as a goal for the future. Suggestions for improving civic engage- Lighter workloads and more fl exible sick ment include reserving seats for older peo- leave for older employees are suggested in ple, improving accessibility at civic events Halifax. Participants in London suggest (e.g. physical accessibility and providing small projects that are interesting to older aids for the hard of hearing) and develop- people and that make use of their skills. In ing or reinstating community boards and Nairobi, Ponce and Tuymazy, participants other participatory bodies. Participants in call for part-time opportunities. In Tokyo, Dundalk consider that better information there is a human resource service for about civic activities would lead to more temporary work, which may suit the needs participation. In Portland, it is suggested of older people. Older people in Tuymazy that older people become involved by voic- consider that consulting work is particu- ing their concerns to government offi cials. larly suited to older people. Older people in La Plata call for more opportunities for political participation by 4. Encouraging civic participation older people, and a role for older people in Reports about the level of civic engagement solving the problems of the community. In vary. In general, older people are interested Tokyo, it is suggested that older people be in and willing to participate in civic func- allocated the specifi c civic role of taking tions. In some places, elders already have an care of the concerns of other older people, active voice through community boards or and participants in Saanich suggest that seniors’ boards. Some cultures reportedly older people be engaged in planning for value the experience and expertise of se- older people. niors 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 leg- islature. Participants in Tripoli report that older people serve on boards of trustees, and in Halifax, older people are involved in helping with elections.

PAGE 55 5. Training 6. Entrepreneurial opportunities Some participants suggest creating entrepre- Now volunteering is a professionalized thing. To be a volunteer you have to go through neurial opportunities for older people as a training. way for them to earn money and participate in the workforce. Financing or otherwise Service provider, London supporting self-employment opportunities are suggested as ways of helping to sup- Training is seen as a way to enable older port older people, and such ideas tend to people to connect with the workforce and come from cities that also report general to participate as volunteers. Some cities re- unemployment or low-income support for port that elders feel they lack the job skills older people (e.g. Cancún, Mexico City, New (largely surrounding the use of technology) Delhi, Ponce, Tripoli, Tuymazy and Udine). needed to compete in the workplace. A few cities report that older people would like Older people in several cities are actively opportunities for training or retraining (al- involved in a variety of self-employed ac- though this is a suggestion more commonly tivities, such as handicrafts and gardening. made by service providers than the elderly In San José, older people ﬁ nd opportunities themselves). In New Delhi, pre-retirement as street vendors. Th ere are opportunities training and retraining is suggested. In for selling hand-made crafts in Cancún, Amman, training older people for light jobs although older people there suggest that that can provide some pay is called for. In having a location for a market would assist Tuymazy, it is felt that training for older them. In Tripoli, it is suggested that non- workers should focus on self-employment governmental organizations could assist and small business opportunities. 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 gener- ate income.

PAGE 56 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

7. Valuing older peoples’ Th e degree to which older volunteers feel contributions their contributions are appreciated and recognized also varies. Certifi cates of appre- Reports of age discrimination in the work- ciation are given out in Geneva. In Nairobi, force are widespread. Th is is manifested in service providers feel that older people are a variety of ways, ranging from feelings of seen as leaders because of their experience disrespect by other workers to a fl at refusal and trustworthiness. by employers to hire older workers. In some cities it is apparently culturally unaccept- In Udine, it is considered that there should able for older people to work after the be more appreciation for the experience of retirement age. Some of these prejudices elders. Some suggest sensitivity training for come from the older people themselves; employers about the needs and qualifi ca- some report that they simply do not want to tion of older workers. In Mexico City, it is work after having worked all their lives felt that societal recognition of the value of older peoples’ expertise and presence in Th ere are reports of older people being the workforce should be increased. Older treated disrespectfully. Others men- people in Jamaica suggest employing older tion that it is diffi cult to work for people people to teach younger people about the younger than themselves, to take positions culture of aging, addressing both participa- that they consider to be beneath them, or to tion and ageism. work in environments where they feel they are being patronized.

PAGE 57 Age-friendly civic participation and employment checklist Volunteering options • Employee organizations (e.g. trade unions) support ﬂ exible options, such as • Th ere is a range of options for older vol- part-time and voluntary work, to enable unteers to participate. more participation by older workers. • Voluntary organizations are well-devel- • Employers are encouraged to employ and oped, with infrastructure, training pro- retain older workers. grammes and a workforce of volunteers. • Th e skills and interests of volunteers are Training matched to positions (e.g. register or • Training in post-retirement opportuni- database). ties is provided for older workers. • Volunteers are supported in their volun- • Retraining opportunities, such as train- tary work, for example by being provided ing in new technologies, is available to with transportation or having the cost of older workers. parking reimbursed. • Voluntary organizations provide training Employment options for their positions. • Th ere is a range of opportunities for older Accessibility people to work. • Opportunities for voluntary or paid work • Policy and legislation prevent discrimina- are known and promoted. tion on the basis of age. • Transportation to work is available. • Retirement is a choice, not mandatory. • Workplaces are adapted to meet the • Th ere are ﬂ exible opportunities, with needs of disabled people. options for part-time or seasonal employ- • Th ere is no cost to the worker of partici- ment for older people. pating in paid or voluntary work. • Th ere are employment programmes and • Th ere is support for organizations (e.g. agencies for older workers. funding or reduced insurance costs) to recruit, train and retain older volunteers.

PAGE 58 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Civic participation Entrepreneurship • Advisory councils, boards of organiza- • Th ere is support for older entrepreneurs tions, etc. include older people. and opportunities for self-employment (e.g. markets to sell farm produce and • Support exists to enable older people to crafts, small business training, and mi- participate in meetings and civic events, cro-ﬁ nancing for older workers). such as reserved seating, support for people with disabilities, aids for the hard • Information designed to support small of hearing, and transportation. and home-based business is in a formats suitable for older workers. • Policies, programmes and plans for older people include contributions from older Pay people. • Older workers are fairly remunerated for • Older people are encouraged to partici- their work. pate. • Volunteers are reimbursed for expenses Valued contributions they incur while working. • Older people are respected and acknowl- • Older workers’ earnings are not deducted edged for their contributions. from pensions and other forms of income support to which they are entitled. • Employers and organizations are sensitive to the needs of older workers. • Th e beneﬁ ts of employing older workers are promoted among employers.

PAGE 59 Part 11. Communication and information

Overview of fi ndings 1. Widespread distribution Focus group participants strongly agree In all cities, local community-wide media are that staying connected with events and singled out as providers of useful information. people and getting timely, practical infor- In developing countries and in the Russian mation to manage life and meet personal Federation, the communication media famil- needs is vital for active ageing. Participants iar to older people tend to be limited to radio, in most cities in the developed world say television and newspapers. In developed there is a variety of information from many countries, an abundance of general and tar- diff erent general and specialized media geted information of interest to older people for older people, while in cities in develop- is described, from diverse sources including ing countries, people in the focus groups the Internet. Valued everywhere is informa- emphasize a few community-wide media, tion that reaches older people in their daily mostly television, radio and newspapers. lives and activities, through direct personal Yet the fear of missing information and delivery, telephone and distribution in key of being left out of the mainstream is locations: community centres and bulletin voiced almost everywhere. Rapidly evolv- boards, public services, libraries, stores, doc- ing information and communication tors’ offi ces and health clinics. Older people in technologies are both welcomed as use- Istanbul report that the telephone is the most ful tools and criticized as instruments of universal and reliable way of communicat- social exclusion. Regardless of the variety of ing with them. Governments and voluntary communication choices and the volume of organizations are seen to have a major role information available, the central concern in ensuring that information is widely avail- expressed in the focus groups is to have able: systematic, eff ective public distribution relevant information that is readily acces- services are valued as an age-friendly feature. sible to older people with varying capacities In Himeji, there is said to be a well-structured and resources. distribution of municipal information to residents’ associations, who pass it on to district It becomes worst [sic] as you get older … leaders who then deliver it to every house- as your faculties begin to fade, this kind hold. In cities where the private sector has yet of thing appears to cause more in terms of to become aware of this growing grey market, stress. such as Tripoli, business too is mentioned as Older person, Halifax 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 60 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Aff ordable access to communication chan- ers in developing countries more often nels and information is essential. Radio is face the problem of insuffi cient up-to-date the mainstay of communication for older information on important matters, such as people in Nairobi because it is cheap; in health, legal rights, benefi t entitlements, Udaipur, local notice boards are important services and community events. It is noted in reaching people from lower socioeco- in La Plata that the general community me- nomic groups. To ensure information ac- dia do not cover topics important for older cess in Tuymazy, free newspaper subscrip- people in enough detail to be useful. tions are provided to retirees by former A frequent suggestion for making com- employers. In Dundalk, the cost of a home munication more age-friendly is to provide telephone line is publicly subsidized for more information targeted to older people people over the age of 70. Free publications through dedicated newspapers or regular and public access to newspapers, computers columns in the general press, as well as and the Internet in community centres and through specialized radio and television libraries, at no or minimal cost, are age- programmes. Another idea is to have com- friendly features in other cities.. munication channels broaden their pro- 2. Th e right information at the right gramming and coverage of issues to include time the interests of an older adult audience. Older people in some cities complain that Much information is available, but fi nding television in particular seems to exclude needed information is complicated. their interests and tastes. Caregiver, Moscow People want information to be coordinated in one easy-to-access service that is widely Regardless of the number and variety of in- known throughout the community. In formation sources, the preoccupation with Portland, the local county has a live 24- getting relevant and timely information is hour telephone information service. Older shared in cities at varying stages of devel- people consulted in New Delhi suggest that opment. In some developed cities, such as a central and respected voluntary organi- Geneva, managing the information over- zation, such as HelpAge India, collect and load is diffi cult and important information organize a database of information relevant may be missed. A frequent barrier is lack of to older people and make it available by awareness of available information or ser- telephone. In Islamabad, a community vices, or not knowing how to locate needed information room with newspapers and information. Th e result is that older people television is recommended. 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 dwell-

PAGE 61 3. Will someone speak to me? the attention of a real person who is helpful, clear and unhurried is highly valued by older Older people call into radio programmes at people around the world. all hours.

Service provider, Mayaguez Every district has a mosque. The Arabic word for mosque is a synonym for the place that brings people together. No matter how developed the city, word of mouth is the principal and preferred means Older person, Tripoli of communication for older people, both through informal contacts with family and Age-friendly communication everywhere friends and through clubs, associations, recognizes and uses these informal chan- public meetings, community centres and nels to reach older people. One way is to places of worship. Radio is a very popular regularly provide relevant information in information source in many cities, with places where older people normally gather; broadcasting in vernacular languages or another is to create social occasions to off er with open-line programmes whereby call- information of interest to them. In Rio de ers ask questions to experts or participate Janeiro, for instance, it is proposed using in on-line discussions. Th e interpersonal the auditorium of the health care centre for dimension of communication is very impor- educational lectures. A third strategy is to tant, and it is repeated that staying active inform individuals who will in turn pass and involved in the community is the best on the information to others, one-to-one. way to remain informed. Regret is expressed Th ese “key informants” can be volunteers, about losing opportunities to interact with as suggested in Jamaica, social and health others as a result of changes, such as new service providers or people in service high-rise buildings in the neighbourhood, industries – estate agents, hairdressers, the closing of community post offi ces, and postal workers, or the doormen in apart- automating banking and other services. Oral ment buildings in Rio de Janeiro who know communication is especially important for each resident and are a recognized source older people who are visually impaired and of informal information and support. for those who are not literate. Illiteracy rates Th e problem of reaching those who are are very high in the older adult population socially isolated – older people who are out in developing countries, and in developed of touch with the world because they live countries, older people on average have a alone with signifi cant impairments and lower level of literacy than younger people. have minimal family support – arises in Th e “grapevine” works too because people richer and poorer cities alike. E-mail and trust the person providing the information the Internet is one solution that is men- and because they can ask questions until they get what they want to know. Receiving

PAGE 62 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

tioned, but rarely. One-to-one outreach by Service automation adds a further layer of trusted individuals is the favoured ap- complexity to daily transactions. Visual proach, through volunteers who visit or displays and buttons on mobile telephones telephone or through social service work- and electronic equipment are too small, ers. Anticipating the locations outside the while automated banking, postal, parking home where older people at risk of social and other ticket machines are all diﬀ erent, isolation may be found is also suggested: are poorly lit and have unclear instructions. the use of the district health clinic as a For people in a wheelchair, the panels are distribution point for information about too high to reach. To make telephones ac- services for older people with health prob- cessible to illiterate older people so they can lems is suggested in San José. call family or services, a suggestion made in Amman, is to colour-code the telephone 4. Age-friendly formats and design buttons and the telephone numbers.

I got a letter yesterday. They’re checking up, Automated answering services are a gen- apparently, on what beneﬁ ts you’re getting eral source of complaint: there is too much …You’ve got to read it about four times to information given too quickly, the choices really understand. are confusing, and there is often no oppor- Older person, London tunity to speak to a live person.

5. Information technology: boon Th e single biggest universal barrier to com- and bane municating with older people is the visual and auditory presentation of information. Information technology, especially comput- Font size on text materials, mainly hard ers and the Internet, is appreciated by some copy but also visual displays such as televi- older people for its comprehensiveness and sion, is too small to read. Product labels and convenience. In Tripoli, older people say instructions, particularly for medications, the Internet is a good way for them to stay are hard to decipher. Page layout is often in touch with children who live far away, confusing, with too much information in a perhaps in other countries. small space. Auditory information is spo- Nevertheless, many older people experience ken too quickly and commercials on radio a sense of exclusion because they do not use and television make older people lose their computers and the Internet. Th e conver- train of thought. Th e language used is often sion of direct services and documentation too complicated, with many unfamiliar to computer technology increases feelings terms. Offi cial forms – which are vital for of exclusion. In developing countries and receiving services and benefi ts – are especially diffi cult to understand.

Write simple, short with big letters.

Service provider, Mexico City

PAGE 63 the Russian Federation, computers are too costly for many older people or just not widely available in the community. In other Age-friendly communication a places, physical access to computers is possible but older people are totally unfamiliar Information off er with the technology and are afraid they • A basic, universal communications sys- cannot learn. Aff ordable public access to tem of written and broadcast media and computers for older people in community telephone reaches every resident. centres, older people’s clubs, public services and libraries is an important age-friendly • Regular and reliable distribution of feature. Computer training, preferably information is assured by government or adapted to individual needs and pace of voluntary organizations. learning and given by a trusted person, is • Information is disseminated to reach strongly advised. In Halifax, for example, older people close to their homes and older people mention a permanent Internet where they conduct their usual activities tutor who is available to help out older of daily life. people individually, visiting them in their • Information dissemination is coordinated homes if requested. in an accessible community service that 6. A Personal and collective is well-publicized – a “one-stop” informa- responsibility tion centre. Like other citizens, older people have a • Regular information and programme personal responsibility to keep abreast of broadcasts of interest to older people new information by staying involved in are off ered in both regular and targeted community activities, and to make an ef- media. fort to adapt to change and take the risk to Oral communication learn. Collectively, governments, voluntary organizations and the private sector are • Oral communication accessible to responsible for removing the communica- older people is preferred, for instance tion barriers that progressively cut older through public meetings, community people off from others, particularly barriers related to poverty, low literacy and dimin- ished capacity.

PAGE 64 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

n and information checklist

centres, clubs and the broadcast media, Automated communication and and through individuals responsible for equipment spreading the word one-to-one. • Telephone answering services give • People at risk of social isolation get instructions slowly and clearly and tell information from trusted individuals callers how to repeat the message at any with whom they may interact, such as time. volunteer callers and visitors, home sup- • Users have the choice of speaking to a port workers, hairdressers, doormen or real person or of leaving a message for caretakers. someone to call back. • Individuals in public offi ces and busi- • Electronic equipment, such as mobile nesses provide friendly, person-to-person telephones, radios, televisions, and bank service on request. and ticket machines, has large buttons Printed information and big lettering. • Printed information – including offi cial • Th e display panel of bank, postal and forms, television captions and text on vi- other service machines is well-illumi- sual displays – has large lettering and the nated and can be reached by people of main ideas are shown by clear headings diff erent heights. and bold-face type. Computers and the Internet Plain language • Th ere is wide public access to comput- • Print and spoken communication uses ers and the Internet, at no or minimal simple, familiar words in short, straight- charge, in public places such as govern- forward sentences. ment offi ces, community centres and libraries. • Tailored instructions and individual assistance for users are readily available.

PAGE 65 Part 12. Community support and health services

Overview of fi ndings with existing services, it also shows that older people in these cities have a level of Health and support services are vital to access to services that may be lacking in maintaining health and independence in other parts of the world. the community. Many of the concerns raised by older people, caregivers and In most collaborating cities, the supply, service providers in the focus groups deal organization and fi nancing of many health with the availability of suffi cient good and social services are decided by the state quality, appropriate and accessible care. or national government rather than the city. Participants in the WHO consultation Also, the supply and professional training report their experiences from the context of health and social workers are outside of very diff erent systems with very diff erent the city’s control. Nevertheless, health and expectations; but nevertheless older people social services are delivered within a city everywhere voice a clear desire for basic by local people in local establishments, and health and income support. Health care community-based for-profi t and voluntary costs are perceived as too high everywhere, groups play an important role in delivering and the desire for aff ordable care is consis- support and care. Public decision-makers tently expressed. and the private and voluntary sectors at the city level do have an infl uence on the num- I’ve run into so many seniors that put off ber, range and location of services and on going to the doctor, and their health just other aspects of the accessibility of facilities deteriorates and deteriorates, because they and services in their territory. Local service don’t have the money. authorities also provide staff training and Older person, Portland set service performance standards. Civil society plays a role in providing fi nancial In many cities in developing countries, a support and voluntary work. In reporting basic shortage of necessary services and the fi ndings and developing a checklist of supplies is observed, and in others, services community and health service features in are found to be poorly distributed. Some of an age-friendly city, the Guide focuses on the most developed countries have, at the those aspects of community support and same time, the greatest volume and range health services that are within the scope of of health and community support services an age-friendly city’s infl uence. and the greatest number of complaints. While this certainly refl ects dissatisfaction

PAGE 66 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Health service issues dominate the focus Barrier-free structures and mobility within group discussions in the majority of cit- health facilities is important, as is the safety ies, reﬂ ecting their importance for active of the buildings. Among the barriers noted ageing. Access to health care as well as to a are poorly maintained elevators and ramps range of health services that are not strictly in Udaipur, poor building access for people medical are major themes. Although less with disabilities and a lack of wheelchairs attention is paid in general to commu- or walking frames for patients in Cancún, nity support and social services, the key and overcrowded facilities in many other attributes of an age-friendly city can be cities. Safety concerns or lack of space in identiﬁ ed from the comments made by the nursing homes are raised in Amman, La participants. Plata and Portage la Prairie.

1. Accessible care Another frequently mentioned barrier to accessing care is insuffi cient knowledge Having well-located, easily accessible health about the health services available in the services is fundamentally important for city. As observed in Melbourne, if services older people in every collaborating city. are not known about they are not used. Older people in cities such as Amman, Rio Better advertising of local health services, de Janeiro, Sherbrooke and Tokyo value educating older people on the health having health services near by, and in system, coordination of information, and Geneva and Shanghai, older people appre- health information telephone services are ciate good transportation to health facili- suggested as possible solutions. ties. Services that are far away or diffi cult to reach are often seen as barriers. Public Finally, the attitudes of health service pro- transportation is considered inadequate in viders towards older people are frequently some places and in others, such as Delhi mentioned. Tuymazy is one of the few and Mexico City, transportation for people places reporting the polite and friendly be- with disabilities is reported to be a par- haviour of clinic receptionists and nurses. ticular problem. Access to health care in Negative attitudes and poor communica- emergency situations is a frequent concern. tion by health providers are common com- Besides particular complaints, such as a plaints about care. Problems voiced include lack of emergency care in some cities, those indiff erence, disrespect, uncaring attitudes, consulted also mention that ambulance and treating older people as a burden or services are either insuffi cient (Ponce) or as a drain on resources. General sugges- too slow because of heavy traffi c (Moscow). tions off ered for improving the attitudes Ways to minimize geographical barriers and behaviour of service providers are to include the idea of co-locating or decentral- improve their communication skills and izing services so they are available in all to train health professionals to treat older neighbourhoods. Other ideas are to off er people better. In Amman, it is suggested transportation by volunteers and to provide that young people be encouraged to do vol- health emergency telephone services, as in untary work caring for older people. Himeji, for older people living alone.

PAGE 67 at home. Older people in Mexico City are When they came to wash and change her pleased with the targeted vaccination cam- they treated her like a piece of furniture – no dignity, no respect. paign and free eyeglasses. Participants in Saanich suggest expanding seniors’ cen- Older person, London tres into community wellness centres, and people in Tuymazy propose providing older 2. A wider range of health services people with subsidized access to health re- sorts (spas). In Islamabad and Mexico City, In all cities, people’s views refl ect the need it is seen as a good idea to provide services for a wide range of health services for older in the local neighbourhoods rather that at a people. Th e availability of various specifi c central point. forms of care for older people emerges either as an asset or as a gap in the urban 4. Home care landscape: geriatric clinic services and hospital beds, adult day centres, care for the One very consistent theme is the need for demented, mental health services, respite a wide range of home support and care care and training for caregivers, rehabili- services – from help with shopping and/or tation and palliative care are mentioned. providing meals to home visits from doc- Along with services, a greater supply of tors and other service providers. With few equipment is recommended, such as wheel- exceptions, the focus group participants chairs, walking frames and hearing aids. want services that would allow them to tend However, the health services that receive to their health and personal care needs in the most attention worldwide are disease their own homes. Barriers experienced in prevention and health promotion, home getting home care services include a gen- care, and nursing (long-term care) homes. eral lack of such services, poor organization of services, restrictive eligibility criteria, 3. Ageing well services high cost, and high turnover in home care staff . Suggestions for improving home care Older people and others in several cities services depend very much on the context. either report a lack of services or pro- In several cities, especially in developing grammes for disease prevention and health countries, the message is simply “provide promotion or include them in their sugges- home care”. In other cities, comments focus tions for improvement. In the list of im- on how to improve the number or range of portant services are preventive screening, services (e.g. physiotherapy and psychologi- physical activity, education on injury pre- cal counselling) or their quality (e.g. provid- vention, nutritional guidance, and mental ing care soon after discharge from hospital, health counselling. Age-friendly features increasing the number of case managers, reported in the Ruhr metropolitan area and always being cared for by the same include self-help groups or organizations person). In some places, comments deal with off ering sports activities for fi tness and ways of managing costs, such as through rehabilitation, and regular health checks insurance coverage or by using the services of a housekeeping cooperative enterprise,

PAGE 68 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

as mentioned in Sherbrooke. In Shanghai, are reported to be provided primarily by caregivers report that people over 80 years families, religious institutions, charitable of age, the widowed, people on a low income organizations or community groups. and the disabled are entitled to one hour per Among the appreciated services off ered by day of free housekeeping. the community are cheaper meals for older people in restaurants in Rio de Janeiro 5. Residential facilities for people and Geneva, help with pensions and other unable to live at home entitlements in Jamaica, and a system for A common concern is the lack of adequate screening contractors and handyman ser- and aff ordable options in the city to care vices in Portland to ensure they are legiti- for older people no longer able to live in mate. Community centres and centres for their own homes. Lack of vacancies and older people are regarded as ideal locations high cost are the most frequent complaints. for social services because of their conve- Caregivers in Portage la Prairie observe nience, familiarity and accessibility. that there is insuffi cient storage space for Several barriers are noted, with more personal eff ects in nursing homes, and frequent and more acute problems in less older people in Geneva suggest that nursing developed regions: services are insuffi cient, homes be located in the centre of the city too costly, diffi cult to access or of poor or have easy access to the centre. Serious quality. As with health services, some par- concerns are expressed in a few cities about ticipants say that they simply do not have safety, substandard care in homes for poor good information about what is available older people, insuffi cient personnel, and or how to access it. Lack of coordination suspected general sedation of residents. among services, causing needlessly com- Ideas for alternative models are proposed: plicated application formalities and gaps in caregivers in Amman suggest establishing services, is also frequently raised as a prob- small homes housing a few residents in- lem. Suggestions for improving commu- stead of the “huge” nursing homes; service nity social services are varied. Improving providers in Jamaica and older people in coordination among services, adding more Udine similarly call for such group homes case managers and integrating service off ering housekeeping and some health and teams are ideas proposed in cities with personal care. well-developed but somewhat fragmented 6. A network of community services service networks. Reducing or facilitating administrative formalities are mentioned in Th e scope of community social services and the majority of cities, regardless of region. the way in which they are provided vary Co-locating social and health services in enormously among cities. In some cities, community or older people’s centres and particularly in developed countries, social providing more funding for services are services are delivered, or funded, by the other recommendations. government. Elsewhere, support services

PAGE 69 Many social services are said to be needed The doorman is really nice, he looks after or improved, often to protect and care for four older people in my building. He bathes older people with low incomes who consti- them, he is a cleaning man and in his lunch tute the majority in many cities. In addition time he helps people. to enhancing basic income support, older people think their cities should establish Older person, Rio de Janeiro or strengthen: shelter and protection for homeless and destitute older people and 8. Other issues people who have been abused; meals ser- Two other concerns are raised in a few cit- vices and programmes; discounts on utili- ies: taking account of older people in emer- ties for people with low incomes; registers gency situations and the lack of cemetery of older people living alone; assistance in space. Although these issues are seldom obtaining pensions and other entitlements; mentioned, they are nevertheless important and spiritual support. A good example in expanding cities. Participants in two described in Mexico City is an ID card for locations perceive a gap in support for older older people, giving the holder access to people in emergencies, such as natural lower prices and some free services. disasters and human confl icts. In Jamaica, 7. Volunteers wanted where hurricanes are frequent, older people comment that churches play a vital role in A consistent theme is the need for vol- providing care during disasters. Service unteers to help fi ll gaps in the health and providers in Amman suggest that the city social services. More volunteers are wanted develop emergency and disaster plans that to assist older people in clinics and hospi- include older people. Although it is not pro- tals, as well as to deliver social services and posed in this context, a useful suggestion home care, to provide transportation for for emergencies made in Dundalk is to have shopping and appointments, or simply to a community register of older people living walk the pets of older people who are no alone. Th e lack of suffi cient cemetery space longer able to do so themselves. Suggested is mentioned very briefl y in Cancún and sources of voluntary help are the “50+” Melbourne; as a solution, service providers associations of young retirees, students in in the latter city suggest having a “vertical” social and health services, and schoolchil- or layered cemetery. dren. 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.

PAGE 70 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Age-friendly community and health services checklist

Service accessibility Off er of services • Health and social services are well-dis- • An adequate range of health and com- tributed throughout the city, are conve- munity support services is off ered for niently co-located, and can be reached promoting, maintaining and restoring readily by all means of transportation. health. • Residential care facilities, such as retire- • Home care services are off ered that ment homes and nursing homes, are include health services, personal care and located close to services and residential housekeeping. areas so that residents remain integrated • Health and social services off ered address in the larger community. the needs and concerns of older people. • Service facilities are safely constructed • Service professionals have appropriate and are fully accessible for people with skills and training to communicate with disabilities. and eff ectively serve older people. • Clear and accessible information is pro- Voluntary support vided about the health and social services for older people. • Volunteers of all ages are encouraged and supported to assist older people in a wide • Delivery of individual services is coor- range of health and community settings. dinated and with a minimum of bureaucracy. Emergency planning and care • Administrative and service personnel • Emergency planning includes older peo- treat older people with respect and sensi- ple, taking into account their needs and tivity. capacities in preparing for and respond- • Economic barriers impeding access to ing to emergencies. health and community support services are minimal. • Th ere is adequate access to designated burial sites.

PAGE 71 Part 13. Wrapping up and moving forward

Active ageing in an age-friendly city determinants of active ageing, more important still are policies that reduce economic Th e starting point for this Guide was the inequalities in access to all the city’s struc- concept that an age-friendly city encour- tures, services and opportunities. ages active ageing by optimizing opportunities for health, participation and security Design for diversity has emerged as a prime in order to enhance quality of life as people characteristic of an age-friendly city that age. Th e assets and barriers reported by is repeated often across many topic areas. approximately 1500 older people and 750 Within the WHO life course perspective caregivers and service providers consulted for active ageing described in Part 2, design in this global project confi rm this idea and for diversity is the key to supporting opti- provide many examples to show how the mal capacity among high-functioning indi- features of city refl ect the determinants of viduals and enabling older people to func- active ageing in many interconnected ways. tion who would otherwise become depen- Th e city’s landscape, buildings, transpor- dent. According to the project participants, tation system and housing contribute to it should be normal in an age-friendly city confi dent mobility, healthy behaviour, for the natural and built environment to social participation and self-determination anticipate users with diff erent capacities or, conversely, to fearful isolation, inactiv- instead of designing for the mythical “aver- ity and social exclusion. A wide range of age” (i.e. young) person. An age-friendly opportunities for age-integrated as well as city emphasizes enablement rather than age-targeted social participation fosters disablement; it is friendly for all ages and strong social connections and personal em- not just “elder-friendly”. Th ere should be powerment. Empowerment and self-worth enough public seating and toilet facilities; are reinforced by a culture that recognizes, dropped curbs and ramps to buildings respects and includes older people. Relevant should be standard features, and lights at information in appropriate formats also pedestrian crossings should be safely timed. contributes to personal empowerment, Building and housing design should be bar- as well as to healthy types of behaviour. rier-free. Information materials and com- Accessible and well-coordinated health munication technologies should be adapted services have an obvious infl uence on older to suit diverse perceptual, intellectual and people’s health status and health behaviour. cultural needs. In a word, spaces and struc- Although opportunities for paid work in tures must be accessible. urban settings are related to the economic

PAGE 72 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Acknowledging and respecting diversity should watch out for each other’s safety should characterize social and service and help and inform each other. Th anks to relationships no less than physical struc- a network of trusted family, friends, neigh- tures and materials. Th e participants in this bours and service providers, older members WHO project make it clear that respect and of the community should feel integrated consideration for the individual should be and safe. Moreover, there should be per- major values on the street, at home and on sonalized outreach to older people at risk of the road, in public and commercial servic- being socially isolated, and the economic, es, in employment and in care settings. In linguistic or cultural barriers experienced an age-friendly city, users of public spaces by many older people should be minimized. should be considerate in sharing the amenities, and priority seating in public transport Integrated and mutually enhancing and special needs stopping and parking urban features areas should be respected. Services should Th e strong connections among the diff er- employ friendly staff who take the time ent aspects of city living made by people to give personal assistance. Tradespeople consulted in the WHO project clearly show should serve older people as well and as that an age-friendly city can only result promptly as other clients. Employers and from an integrated approach centred on agencies should off er fl exible conditions how older people live. Taking this approach and training to older workers and volun- means coordinating actions across diff er- teers. Communities should recognize older ent areas of city policy and services so that people for their past contributions, not only they are mutually reinforcing. Based on the for their current ones. Because education reports of the older people and others in fosters awareness, schoolchildren should be the project, joint action that respects the taught about ageing and older people and following relationships appears especially the media should portray them in realistic important. and non-stereotypical ways. • Housing must be considered in connec- Th e life course approach includes all ages tion with outdoor spaces and the rest of within the process of promoting active the built environment such that older ageing. It also embraces the value of in- people’s homes are located in areas safe tergenerational solidarity. In the view of from natural hazards and are close to the project participants, another impor- services, other age groups and civic at- tant characteristic of an age-friendly city tractions that keep them integrated in the is that it should foster solidarity between community, mobile and fi t. generations and within communities. An • Transportation services and infrastruc- age-friendly city should facilitate social tures must always be linked to opportu- relationships – in local services and in the nities for social, civic and economic par- activities that bring together people of all ticipation, as well as to access to essential ages. Opportunities for neighbours to get health services. to know each other should be fostered; they

PAGE 73 • Social inclusion of older people must Guide and checklists to initiate age-friendly target social arenas and roles that carry city development. Currently being consid- power and status in society, such as deci- ered are country-level networks, for exam- sion-making in civic life, paid work and ple in Japan and Spain, as well as regional media programming. “hubs” in the Middle East, in Canada and in Latin America and the Caribbean. To • Because knowledge is key to empower- facilitate the spread of age-friendly cities, ment, information about all aspects of translation of the Guide into several lan- city living must be accessible to everyone guages is under way, including Chinese, at all times. French, German, Japanese, Portuguese and Beyond the age-friendly city guide Spanish. Because the age-friendly cities idea and checklists has much in common with the successful Th is project is a starting point for many and eff ective Healthy Cities concept, an more community development and re- active and mutually benefi cial link between search activities, as well as for the estab- the two networks is being pursued. Within lishment of a larger global network of WHO, the Ageing and Life Course pro- age-friendly communities. Th e next steps gramme will continue to provide an insti- for collaborating cities and for WHO will tutional “home” for the WHO age-friendly be to confi rm the validity of the checklists. city initiative. One city has already conducted site visits to Focus group participants reported several verify the barriers in the natural and built examples of age-friendly practices in their environments and in services that were re- cities. Some of these have been very briefl y ported by older people. Others are return- mentioned in this Guide. Another impor- ing to the original focus group participants tant step will be to obtain further informa- to determine whether the features in the tion about these initiatives from the project Guide accurately capture what they said, leaders and to publish an inventory of these or are setting up focus groups with older good practices. A conference to exchange people in other locations to assess the level local and international age-friendly city ini- of agreement between their views and the tiatives was held in June 2007 in the Ruhr checklists. Another approach to validation metropolitan area, sponsored by the State will involve experts in the fi eld of ageing, Government of North Rhine Westphalia, who will compare the checklists based on to mark the selection of the city of Essen the views of older people with evidence as a European Capital of Culture for 2010. from gerontological research and practice. A further best practices meeting is being At the same time, many other cities have planned for Istanbul, also in connection expressed an interest in using the WHO with the selection of this city as the other 2010 European Capital of Culture. To gen- erate more good practices from the WHO research, experts and service providers will

PAGE 74 AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

be invited to identify interventions corre- cities in diff erent regions of the world, will sponding to the age-friendly features in the be conducted to address these specifi c de- checklists. Th e current checklists also will terminants, beginning with an initiative led be tested in at least one location for their by the New York Academy of Medicine on usefulness in creating age-friendly inter- the theme of “ageing in a foreign land”. ventions. Finally, non-urban communities must Th e research leading to the Guide has yield- also become more age-friendly. In many ed many rich fi ndings worldwide, as well as countries, older people constitute a high connections among researchers concerned percentage of the population in rural and with ageing and the environment. With remote areas as a consequence of the emi- the support of the Institute of Aging of the gration of younger people. Canadian federal Canadian Institutes of Health Research, and provincial governments are leading a collaboration among researchers is being project to identify the age-friendly com- encouraged to advance knowledge about munity features in several small towns and ageing in urban settings. Technical re- villages, and the results will eventually be search papers are planned that will describe shared worldwide. more fully the concept and methodology Th ere is already much enthusiasm for dis- of the WHO-led research, more closely seminating and adopting the Guide and examine age-friendly settings in relation checklist. New initiatives and collabora- to active ageing, and reveal evidence of the tors in a worldwide network are welcome. convergences between ageing, urbanization Active ageing in supportive, enabling cities and globalization – the major forces shap- will serve as one of the most eff ective ap- ing the 21st century that are central to this proaches to maintaining quality of life and project. prosperity in an increasingly older and As stated earlier, the present research did more urban world. 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

PAGE 75 References

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PAGE 76 Global Age-friendly Cities: A Guide