The beginning of the 21st century has seen health systems worldwide struggling to deliver quality healthcare amidst challenges posed by ageing populations. The increasing prevalence of frailty with older age and accompanying complexities in physical, cognitive, social and psychological dimensions renders the present modus operandi of fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In line with the public health framework for action in the World Health Organization’s World Health and Ageing Report, meeting these challenges will require a systemic reform of healthcare delivery that is integrated, patient-centric, team-based, and health-centered. These reforms can be achieved through building partnerships and relationships that engage, empower, and activate patients and their support systems. To meet the challenges of population ageing, Singapore has reorganised its public healthcare into regional healthcare systems (RHSs) aimed at improving population health and the experience of care, and reducing costs. This paper will describe initiatives within the RHS frameworks of the National Health Group (NHG) and the Alexandra Health System (AHS) to forge a frailty-ready healthcare system across the spectrum, which includes the well healthy (“living well”), the well unhealthy (“living with illness”), the unwell unhealthy (“living with frailty”), and the end-of-life (EoL) (“dying well”). For instance, the AHS has adopted a community-centered population health management strategy in older housing estates such as Yishun to build a geographically-based care ecosystem to support the self-management of chronic disease through projects such as “wellness kampungs” and “share-a-pot”. A joint initiative by the Lien Foundation and Khoo Teck Puat Hospital aims to launch dementia-friendly communities across the island by building a network comprising community partners, businesses, and members of the public. At the National Healthcare Group, innovative projects to address the needs of the frail elderly have been developed in the areas of: (a) admission avoidance through joint initiatives with long-term care facilities, nurse-led geriatric assessment at the emergency department and geriatric assessment clinics; (b) inpatient care, such as the Framework for Inpatient care of the Frail Elderly, orthogeriatric services, and geriatric surgical services; and (c) discharge to care, involving community transitional care teams and the development of community infrastructure for post-discharge support; and an appropriate transition to EoL care. In the area of EoL care, the National Strategy for Palliative Care has been developed to build an integrated system to: provide care for frail elderly with advance illnesses, develop advance care programmes that respect patients’ choices, and equip healthcare professionals to cope with the challenges of EoL care. Full article

A majority of urban residents in sub-Saharan Africa (SSA) and other developing regions live in informal settlements, or slums. Much of the discourse on slum health centres on younger generations, while an intensifying agenda on healthy ageing as yet lacks a systematic focus on slums. Similarly, the global age-friendly cities (AFC) movement does not, thus far, extend to slums. This paper examines the particular challenges that a slum-focused age-friendly initiative in SSA may need to address, and the relevance of present AFC indicators and domains for initiatives to advance the health and well-being of older slum dwellers. The analysis builds on the case of two slum communities in Nairobi, Kenya. It analyzes two bodies of relevant evidence from these settlements, namely on the health and social circumstances of older residents, and on the local application and measurement of AFC indicators. The findings point to a set of unsurprising, but also less obvious, core health and social adversities that an age-friendly initiative in such settlements would need to consider. The findings show, further, that the current AFC domains and indicators framework only partly capture these adversities, but that there is potential for adapting the framework to be meaningful for slum settings. The paper concludes by underscoring the need for, and opportunities inherent in, the pursuit of an “age-friendly slums” initiative going forward. Full article

This study examined the cross-sectional associations between perceived neighborhood walkability and walking time, physical activity, wellbeing, and loneliness, and examined which components of walkability were most strongly associated with better wellbeing and less loneliness in older adults. Participants were community-dwelling Chinese adults aged 60+ (n = 181). Walkability was measured using nine items selected from the Chinese version of the abbreviated Neighborhood Environment Walkability Scales (NEWS) and NEWS for Chinese Seniors. Outcomes were walking time, physical activity, wellbeing (life satisfaction, happiness, sense of purpose and meaning in life), and loneliness. The mean age of the participants was 71.7 ± 7.8 years. Walkability was positively associated with walking time (p = 0.001, p for trend <0.001) but not with physical activity. After adjusting for socio-demographic characteristics, health conditions, lifestyle, and negative life events, those who perceived their neighborhoods as walkable had higher scores for life satisfaction (p = 0.002) and happiness (p = 0.002), and lower scores for loneliness (p = 0.019), compared with those who perceived their neighborhoods as less walkable. However, perceived neighborhood walkability was not associated with sense of purpose and meaning in life. Among components of walkability, land use mix-access, infrastructure and safety for walking, and traffic safety showed the strongest associations with the measures of wellbeing. The results of this study support the importance of neighborhood walkability for health behavior and wellbeing of older adults. The wellbeing of older adults may be enhanced through the improvement of land use mix-access, infrastructure for walking, and traffic safety. Full article

This study aimed to compare the prevalence of frailty across three Chinese populations: Hong Kong, Taiwan-urban and Taiwan-rural. Contributing factors to disparities in frailty were also examined. Data were derived from the Osteoporotic Fractures in Men (MrOs) and Women (MsOs) (Hong Kong) Study (n = 4000) and the Taiwan Longitudinal Study on Aging (n = 2392). Frailty was defined as an index calculated from 30 multiple deficits. The ratio of the frailty index to life expectancy at birth (FI/LE) was used as an indicator of compression of morbidity. Frailty was more prevalent in Taiwan-urban (33.1%) and Taiwan-rural (38.1%) compared to Hong Kong (16.6%, p < 0.05) and was higher in women (22.6–49.7%) than in men (10.5–27.5%, p < 0.05). The ratios of FI/LE were higher in Taiwan-urban and Taiwan-rural (both 0.27) compared to Hong Kong (0.20, p < 0.05). Multivariate analyses revealed that older age, being a woman and low levels of physical activity were common risk factors for frailty across the three populations. Alcohol use was inversely associated with frailty in both Hong Kong and Taiwan-urban populations, but not in Taiwan-rural. Living alone was associated with frailty in Hong Kong men, but not in Hong Kong women or Taiwanese people. For all study populations, older age and being a woman constituted the highest attributable factor. This comparison provides useful data to inform government policies. Full article

Previous studies found a relationship between geriatric depression and social deprivation. However, most studies did not include environmental factors in the statistical models, introducing a bias to estimate geriatric depression risk because the urban environment was found to have significant associations with mental health. We developed a cross-sectional study with a binomial logistic regression to examine the geriatric depression risk of a high-density city based on five social vulnerability factors and four environmental measures. We constructed a socio-environmental vulnerability index by including the significant variables to map the geriatric depression risk in Hong Kong, a high-density city characterized by compact urban environment and high-rise buildings. Crude and adjusted odds ratios (ORs) of the variables were significantly different, indicating that both social and environmental variables should be included as confounding factors. For the comprehensive model controlled by all confounding factors, older adults who were of lower education had the highest geriatric depression risks (OR: 1.60 (1.21, 2.12)). Higher percentage of residential area and greater variation in building height within the neighborhood also contributed to geriatric depression risk in Hong Kong, while average building height had negative association with geriatric depression risk. In addition, the socio-environmental vulnerability index showed that higher scores were associated with higher geriatric depression risk at neighborhood scale. The results of mapping and cross-section model suggested that geriatric depression risk was associated with a compact living environment with low socio-economic conditions in historical urban areas in Hong Kong. In conclusion, our study found a significant difference in geriatric depression risk between unadjusted and adjusted models, suggesting the importance of including environmental factors in estimating geriatric depression risk. We also developed a framework to map geriatric depression risk across a city, which can be used for identifying neighborhoods with higher risk for public health surveillance and sustainable urban planning. Full article

Increasing numbers of older people relocate into senior housing when their physical performance declines. The change in social environment is known to affect their wellbeing, providing both challenges and opportunities, but more information on the relations between social and physical parameters is required. Thus, we elicited perceptions of the social environment of 81 older people (aged 59–93 years, living in northern Finland) and changes in it 3 and 12 months after relocation to senior housing. We also measured their physical performance, then analysed associations between the social and physical variables. Participants reported that they had freedom to do whatever they liked and generally had enough contact with close people (which have recognized importance for older people’s wellbeing), but changes in their physical condition limited their social activity. Moreover, their usual walking speed, dominant hand’s grip strength and instrumental activities of daily living (IADL) significantly decreased. The pleasantness of the residential community, peer support, constraints on social activity imposed by changes in physical condition, meaningful activity at home and meeting close people all affected these physical performance parameters. Clearly, in addition to assessing physical performance and encouraging regular exercise, the complex interactions among social factors, physical performance and wellbeing should be considered when addressing individuals’ needs. Full article

Loneliness is a common experience among older people that is associated with health risks and negative well-being. As a psychological phenomenon, it has typically been defined in Western research literature as the discrepancy between desired and actual interpersonal relations. In our qualitative study in Hong Kong, we offer insight into ageing and loneliness in an urban environment of the non-Western world and propose to reconceptualise loneliness by exploring older people’s experience of alienation at the societal level as an important but often neglected dimension of their loneliness. Thirty-seven community-dwelling, Chinese adults aged 65 and above were interviewed in focus groups and their accounts analysed and interpreted using a phenomenological approach. Findings revealed that focus group participants perceived insufficient care for older people, a growing distance between themselves and society, and their disintegrating identity in society to be primary sources of societal alienation. In response, older people adopted a more passive lifestyle, attributed marginalisation and inequality to old age, and developed negative feelings including unease towards ageing, vulnerability and helplessness, and anger. The emergence of these key components and underlying themes of societal alienation illuminated neglected facets of the psychological phenomenon of loneliness and highlighted new implications for policy, practice, and research from a societal perspective to address older people’s loneliness in urban settings. Full article

In Mexico, many seniors are alone for most of the day or live in public nursing homes. Simple interaction with computer systems is required for older people. This is why we propose the exploration of a medium well known by seniors, such as the television (TV). The primary objective of this study is to improve the quality of life of seniors through an easier reminder system, using the television set. A technological platform was designed based on interactive television, through which seniors and their caregivers can have a better way to track their daily activities. Finally, an evaluation of the technology adoption was performed with 50 seniors living in two public nursing homes. The evaluation found that the elderly perceived the system as useful, easy to use, and they had a positive attitude and good intention to use it. This helped to generate initial evidence that the system supported them in achieving a better quality of life, by reminding them to take their medications and increasing their rate of attendance to their medical appointments. Full article

In response to the growing number of older people living in cities, the World Health Organization (WHO) introduced the concept of “Age-Friendly Cities” (AFC) to guide the way in designing physical and social environments to encourage active ageing. Limited research has studied the effects of neighbourhood age-friendliness on elderly health outcomes. Using the example of a highly urbanized city in Asia, this study examined the effects of perceived age-friendliness of neighbourhood environments on self-rated health (SRH) among community-dwelling older Chinese. A multi-stage sampling method was used to collect views of community-dwelling older people from two local districts of Hong Kong. A structured questionnaire covering the WHO’s eight AFC domains was developed to collect information on the perceived neighbourhood environments, SRH and individual characteristics. Age-friendliness of neighbourhood was assessed by mean scores of AFC domains, which was used to predict SRH with adjustment for individual and objective neighbourhood characteristics. Furthermore, 719 respondents aged ≥60 years completed the questionnaire, of which 44.5% reported good SRH. Independent of individual and objective neighbourhood characteristics, multiple logistics regressions showed that higher satisfaction on outdoor spaces and buildings, transportation, housing, social participation, and respect and social inclusion was significantly associated with increased odds of reporting good SRH by more than 20% (p < 0.05). Individuals aged 70–79 years, being female, lower education and residents of public or subsidized housing were less likely to report good SRH, after controlling for individual and neighbourhood characteristics. In addition to age, gender, education and housing type, AFC environments have important contributive influence on SRH, after controlling for individual and objective neighbourhood characteristics. Full article

Influenced by a special local environment, the proportion of centenarians is particularly high in some places, known as “blue zones”. Blue zones are mysterious regions that continue to attract research. This paper explores the spatial distribution of the longevity population in a typical Chinese longevity region. Longevity evaluation indexes are used to analyze the longevity phenomenon in 88 towns between 2011 and 2015. Our research findings show that longevity is more important than birth rate and migration in shaping the degree of deep aging in the research region. Fluctuations in the proportion of centenarians are much higher than for nonagenarians, both in relation to towns and to years. This is because there are so few centenarians that data collected over a short time period cannot accurately represent the overall degree of longevity in a small region; data and statistics must be collected over a longer time period to achieve this. GIS analysis revealed a stable longevity zone located in the center of the research region. This area seems to help people live more easily to 90–99 years old; however, its ability to help nonagenarians live to 100 is a weaker effect. Full article

Preventing frailty and its adverse health outcomes is crucial in countries with a large elderly population, such as Japan. Since the long-term care insurance (LTCI) system was launched, the number of certified older adults with LTCI service requirement has continued to increase. This is a serious problem, because the LTCI service requirement certification is equivalent to disability. The aim of this study was to evaluate the effect of a self-management group intervention on new LTCI service requirement certifications in community-dwelling older adults in Japan. We analyzed the cohort data from a prospective study. In this study, we recruited community-dwelling adults aged 65 years and older who were independent in a city in Kyoto prefecture in 2012. The subjects in the participation group (n = 1620) attended 60-min group training sessions once or twice every two weeks from December 2012 to December 2016. The exercise sessions consisted of mild-intensity aerobic exercise, mild strength training, flexibility and balance exercises, and cool-down activities. These exercise classes were facilitated by well-trained volunteer staff. The outcome measure was the number of new LTCI requirement certifications during a four-year follow-up period. During the four-year follow-up period, 247 subjects (15.2%) in the participation group and 334 (20.6%) in the control group were newly certified for LTCI service requirements. The hazard ratio for new LTCI service requirements in the participation group compared with the control group was 0.73 (95% CI = 0.62–0.86) in the four-year follow-up period. These results indicate the usefulness of self-management group exercise to reduce the incidence of disability in older adults. Thus, increasing self-management group activities in each community should be encouraged. Full article

Population ageing is occurring in all countries, regardless of the level of economic development. While the rising burden of chronic diseases and disabilities as a consequence of this demographic transition is well recognized, the increasing prevalence of geriatric syndromes as a public health issue is not as well recognized. Recently the World Health Organization’s World Health and Ageing Report emphasized functional ability as an important outcome for aging populations, highlighting the concept of raising intrinsic capacity throughout the life course. The complementary perspective is the prevention of frailty, which has physical, cognitive, social and psychological dimensions. Therefore, services for older people should encompass medical as well as social components. The need and evolution for a transition in health and social services in Hong Kong, a special administrative region of China which has a population with the world’s highest life expectancy, is presented as an example of how one developed economy attempts to meet the challenges of population ageing. There is a need to shift to integrated care in the community instead of specialty dominated hospital care, and to establish regular activities in the community to adopt and maintain a lifestyle that reduces frailty and disability (or promotes intrinsic capacity). A top down approach with financial incentives, together with public education to help drive policy changes, are key drivers of change. It is expected that there will be much heterogeneity between different countries in terms of barriers and facilitators, such that each country needs to document their needs and design appropriate services. Full article

The aim was to study objectively assessed walkability of the environment and participant perceived environmental facilitators for outdoor mobility as predictors of physical activity in older adults with and without physical limitations. 75–90-year-old adults living independently in Central Finland were interviewed (n = 839) and reassessed for self-reported physical activity one or two years later (n = 787). Lower-extremity physical limitations were defined as Short Physical Performance Battery score ≤9. Number of perceived environmental facilitators was calculated from a 16-item checklist. Walkability index (land use mix, street connectivity, population density) of the home environment was calculated from geographic information and categorized into tertiles. Accelerometer-based step counts were registered for one week (n = 174). Better walkability was associated with higher numbers of perceived environmental facilitators (p < 0.001) and higher physical activity (self-reported p = 0.021, step count p = 0.010). Especially among those with physical limitations, reporting more environmental facilitators was associated with higher odds for reporting at least moderate physical activity (p < 0.001), but not step counts. Perceived environmental facilitators only predicted self-reported physical activity at follow-up. To conclude, high walkability of the living environment provides opportunities for physical activity in old age, but among those with physical limitations especially, awareness of environmental facilitators may be needed to promote physical activity. Full article

Studies on the significance of age-friendly environments towards quality of life among older adults have been limited. This study aimed to examine the association between age-friendly environments and quality of life among Thai older adults. Cross-sectional interview survey data were collected from 4183 older adults (≥60 years) using multistage stratified systematic sampling from all four regions in Thailand. The outcome variable was the World Health Organization Quality of Life (WHOQOL-BREF) scale, while independent variables included sociodemographic factors, having a health problem, and neighbourhood age-friendly environment variables. In multivariable logistic regression, significant age-friendly environments predictors of quality of life included walkable neighbourhood, neighbourhood aesthetics, neighbourhood service accessibility, neighbourhood criminal safety, neighbourhood social trust, neighbourhood social support, and neighbourhood social cohesion. The present study confirms the important role of age-friendly neighbourhoods in terms of physical and social environments towards the quality of life of older adults. Full article