Urban environments for healthy ageing a global perspective

Bringing together stakeholders from Asia, Australia, Europe, and North America, this book presents new evidence and critical reviews of current knowledge to promote ongoing discussions o

Urban Environments for Healthy Ageing

Around the world, researchers, policymakers, and practitioners are working to ensure cities and communities are prepared for the challenges and opportunities of aged and highly urbanised populations Bringing together stakeholders from Asia, Australia, Europe, and North America, this book presents new evidence and critical reviews of current knowledge to promote ongoing discussions on: affordable and accessible housing to support ageing in place; built environment supports for health-enhancing physical activity and mobility; and planning and design strategies and approaches to promote healthy and active ageing in cities and communities The book content is framed by socioecological models of age-ing and well-beage-ing that emphasise the dynamic interconnections between people and environment Contributions in this edited volume stem from the Interna-tional Ageing Urbanism Colloquium, 2017, Singapore University of Technology and Design.

Anna P Lane is a research fellow at the Lee Kuan Yew Centre for Innovative

Cities, Singapore University of Technology and Design She is a developmental psychologist and gerontologist with a general research interest that focusses on better understanding the psychological, social, and environmental predictors of healthy ageing.

261 The Marginalized in Genocide Narratives

Giorgia Donà

262 The Social Structures of Global Academia

Edited by Fabian Cannizzo and Nick Osbaldiston

263 Citizenship in the Latin American Upper and Middle Classes

Ethnographic Perspectives on Culture, Politics, and Consumption

Edited by Fabian Cannizzo and Nick Osbaldiston

264 Youth and the Politics of the Present

Constructing the Future

Edited by Enzo Colombo and Paola Rebughini

265 Trade Unions and European Integration

A Question of Optimism and Pessimism?

Edited by Johannes M Kiess and Martin Seeliger

266 Globalization, Modernity and the Rise of Religious Fundamentalism

The Challenge of Religious Resurgence against the “End of History” (A Dialectical Kaleidoscopic Analysis)

Dimitrios Methenitis

267 Urban Environments for Healthy Ageing

A Global Perspective

Edited by Anna P Lane

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Urban Environments for Healthy Ageing

A Global Perspective

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List of figures vii

1 Housing for older Australians: changing capacities

4 Neighbourhood built environment and older adults’

E S T E R C E R I N, A N DR E A N AT H A N, J E L L E VA N C AU w E N BE RG , A N D A N T HON Y BA R N ET T

Contents

5 Life-space mobility and active ageing 89

8 Age-friendly communities: community environments

11 Designing digital services to enhance older person’s

Y UA N LU, R E N S BR A N K A E R T, C A R L I J N VA L K , M A R JOL E I N DE N H A A N, A N D X I PE I R E N

I.1 Life span approach to ageing 6 1.1 Housing type in the HAIL Study (according to gender) 18 1.2 Housing type in ALSwH (according to year/age) 19 1.3 An ecological model of housing in the context of people’s lives 20

3.1 Remodelled bathroom eliminating level difference

3.2 Several handrails to assist posture when using the bathtub 59 3.3 A comparison of two types of floor plan in multifamily

housing On the right, the toilet is on the other side of the centre-corridor, thus eliminating the possibility of combining

7.1 Spatial distribution of commercial/activity centres in

7.2 Spatial distribution of non-work trip generation rate at

7.3 Spatial distribution of non-work trip generation rate for older

7.4 Spatial distribution of percentage of trips by walking at

7.5 Spatial distribution of percentage of older adult trips by

7.6 Spatial distribution of residents aged 55 and over at subzone

7.7 Spatial distribution of percentage of trips by public transit at

7.8 Spatial distribution of percentage of older adult trips by public

7.9 Spatial distribution of percentage of trips by private vehicle/

7.10 Spatial distribution of percentage of older adult trips by

private vehicle/taxi at subzone level (by quintiles) 133

List of figures

7.11 Spatial pattern of non-work trips oriented towards the CBD

7.12 Spatial pattern of non-work trips oriented towards the CBD

7.13 Spatial pattern of non-work trips oriented towards regional

7.14 Spatial pattern of non-work trips oriented towards regional

7.15 Spatial pattern of non-work trips oriented towards subregional

7.16 Spatial pattern of non-work trips oriented towards subregional

7.17 Spatial pattern of non-work trips oriented towards town

7.18 Spatial pattern of non-work trips oriented towards town

8.1 Active ageing in place: domains of supportive elements 151 8.2 Characteristics of elder-friendly, ageing-friendly, age-friendly,

8.3 Visual illustration of age-friendly neighbourhood concept 165

9.4 A wheelchair ramp instead of stairs is convenient for everyone 179 9.5 An obstacle caused by fixed furniture for someone in a wheelchair 180 9.6 A potential obstacle for someone in a wheelchair 181 9.7 The placement of elements can present as obstacles for older

9.10 Tiles in wet weather are a potential hazard 183 9.11 Adequate lighting is necessary for the safety of older residents 184 9.12 Colour contrasting pavements can assist with wayfinding 185 9.13 Decorative elements can assist with wayfinding 185 9.14 Design elements such as a floor tile can assist with wayfinding 186 9.15 Festive, decorative elements can assist with wayfinding 186

9.16 An example of a conflict point between a vehicle and a

9.17 The potential of interstitial or spillover spaces (a) 188 9.18 The potential of interstitial or spillover spaces (b) 188

9.20 An unloved spillover space that is waiting to become

9.21 Shared green spaces invite social engagement 190 10.1 Confusing road markings and paving patterns, as well

as missing or unclear signage, may obscure intersections

10.2 View of a typical void deck, Bukit Panjang neighbourhood 204

I.1 Ten countries or areas with the largest share of persons aged

60 years or over, in 1980, 2017, and 2050 3 1.1 Limitation on physical functioning items at ALSwH survey

2 in 1999 (73–78 yrs) by housing patterns, and percentage in

residential aged care or deceased by survey 6 in 2011 (85–90 yrs) 26 2.1 Size of public housing flats in Singapore 39 2.2 Preferred housing options if respondent/spouse became

dependent on others and needed assistance 44 2.3 Most important reason for not moving 44 2.4 Housing modifications 46 2.5 Main concern about future housing need 46 4.1 Relationships between neighbourhood environmental

attributes and older adults’ PA: summary of findings 72 7.1 Average daily trips and percentage of trips by purpose 119 7.2 Percentage of travel mode share 121 7.3 Summary statistics of subzone-level trip generation rate and

the dissimilarity index 125 7.4 Summary statistics of subzone-level trip distribution by

purposes (%) 125 7.5 Summary statistics of subzone-level modal splits (%) and the

dissimilarity index 127 7.6 Summary statistics of non-work trips ended at the CBD 134 7.7 Summary statistics of non-work trips ending at regional centres 135 7.8 Summary statistics of non-work trips ending at subregional

centres 137 7.9 Summary statistics of non-work trips ending at town centres 140 8.1 Environmental supports for active ageing in place, best

practice examples: housing 157 8.2 Environmental supports for active ageing in place, best

practice examples: transportation 158 8.3 Environmental supports for active ageing in place, best

practice examples: public open spaces 159

List of tables

8.4 Environmental supports for active ageing in place, best

practice examples: sociocultural environments 161 11.1 Summary of the strategies used, and the stakeholders involved

in the design cases 220

1.1 The Housing and Independent Living Study (HAIL) 18 1.2 The Australian Longitudinal Study on women’s Health

(ALSwH) 19

List of boxes

Anthony Barnett is an associate professor in the Mary MacKillop Institute for

Health Research of the Australian Catholic University He is an exercise phys-iologist His research focusses on environmental determinants of health and the measurement of physical activity.

Rens Brankaert is an assistant professor of Active and Healthy Ageing with a

specific interest in dementia in the systemic change group in the Department of Industrial Design at Eindhoven University of Technology, the Nether-lands He follows a living lab methodology and approaches technology design from a person-centred perspective He is interested in the impact of design on stakeholders and organisations in healthcare.

Julie E Byles is a professor, the Global Innovations Chair in Responsive

Tran-sitions in Health and Ageing, and the Director of the Research Centre for Generational Health and Ageing – a Priority Research Centre at the Univer-sity of Newcastle, Australia Her research interests in ageing include the role of health services, preventive activities, and treatments in maintaining quality of life for older people.

Ester Cerin is an Australian Research Council Future Fellow and professor in

the Mary MacKillop Institute for Health Research of the Australian Catholic University Her research focusses on environmental and psychosocial deter-minants of physical activity and health across the lifespan in diverse geo-graphical locations.

Joshua Comaroff is an assistant professor in Architecture and Sustainable

De-sign at Singapore University of Technology and DeDe-sign His training is in architecture, landscape architecture, and urban geography His research is concerned with emerging cities in Asia, with a particular focus on the social and physical environment of Singapore.

Marjolein den Haan is a PhD candidate in the Department of Industrial

De-sign at Eindhoven University of Technology, the Netherlands Her research focusses on co-designing with older adults for positive ageing, with a specific interest in using leisure activities to create personalised designs.

List of contributors

Yuting Hou  is a research fellow at the Lee Kuan Yew Centre for Innovative

Cities, Singapore University of Technology and Design She is interested in research on evolutions in metropolitan spatial structure, transportation and economic development, land use and accessibility, and spatial analysis.

Sungyop Kim is an associate professor of Urban Planning and Design at the

University of Missouri – Kansas City His research interests include the built environment, urban transportation, travel behaviour, and traffic safety issues associated with older adults.

Satoshi Kose  is a professor emeritus at Shizuoka University of Art and

Cul-ture, Japan Previously, he was with the Building Research Institute of Japan, where he worked for many years to develop dwelling design guidelines for an ageing society.

Chanam Lee is a professor of Landscape Architecture and Urban Planning and

Founding Director of Design Research for Active Living at Texas A&M Uni-versity, United States of America Her expertise is in “active living research,” a transdisciplinary area of research that deals with environmental and policy approaches towards promoting physical activity.

Yuan Lu is an associate professor of Design for Healthy and Active Ageing in the

systemic change group in the Department of Industrial Design at Eindhoven University of Technology, the Netherlands Her research interests include creating new design research methods, tools and technological prototypes to support multi-stakeholder design and innovation on societal challenges.

Gillian McFeat Lin is the director of Tierra Design Studio, an award-winning

architecture, landscape architecture, master planning, and urban design prac-tice based in Singapore Her area of expertise is inclusive design that considers older persons She was awarded the Order of Australia in 2015.

Adithi Moogoor is a research assistant at the Lee Kuan Yew Centre for

Inno-vative Cities, Singapore University of Technology and Design Her research interests include spatial urban analyses, public spaces, and urban design.

Andrea Nathan is the project coordinator for the (Australian) National Health

and Medical Research Council-funded How Areas in Brisbane Influence healTh and AcTivity HABITAT Study Her research interests focus on the built environment and healthy ageing.

Erja Portegijs is a senior researcher at the Gerontology Research Center and

Faculty of Sport and Health Sciences, University of Jyväskylä, Finland Her research interests include person-environment interactions in mobility, physi-cal activity, and active ageing.

Taina Rantanen is a professor of gerontology and public health at

Gerontol-ogy Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Finland Her research interests include mobility, life-course influ-ences on ageing, and promoting active ageing.

Xipei Ren  is a postdoctoral researcher at Eindhoven University of

Technol-ogy, Industrial Design department, and HumanTotalCare His research in-vestigates design and evaluation of data-enabled, interactive, sociotechnical product-service-systems to promote office vitality He is interested in Human Computer Interaction HCI for health, gerontechnology, persuasive design, and calm technology.

Gudmundur F Ulfarsson is a professor of Transportation Engineering at the

University of Iceland His research interests include ageing, traffic safety, and econometric analysis.

Carlijn Valk is a PhD candidate at Eindhoven University of Technology, in the

Department of Industrial Design Her current PhD research focusses on per-sonalising behaviour change strategies to promote healthy and active ageing.

Jelle Van Cauwenberg is a postdoctoral research fellow at the Department of

Public Health, Ghent University His research focusses on the environmental determinants of physical activity among older adults.

Belinda Yuen is a Professorial Fellow and Research Director at the Lee Kuan

Yew Centre for Innovative Cities, Singapore University of Technology and Design, where she directs the Lee Li Ming Programme in Ageing Urbanism She is interested in the study of cities, and in particular in understanding the interactions between the urban built environment and its social, cultural and environmental dynamics

Sinan Zhong is a doctoral candidate in the Urban and Regional Sciences

pro-gramme at Texas A&M University, with a Master’s degree in Landscape Architecture Her research interests are in healthy ageing in place and inter-generational communities.

In 2017, according to the United Nations, there was an estimated 962 million people aged 60 and over in the world, making up 13% of the global population In 2030, the number of older persons in the world is projected to increase to 1.4 billion, and to 2.1 billion by 2050.

Growing old is not just an issue from the individual’s perspective, or the com-munity or country It is a global phenomenon The consequences of an ageing population have ramifications for all levels and aspects of society starting with ageing and longevity, ageing and health, ageing and the labour market, ageing and education, ageing and the family, ageing and mobility, and ageing and the built environment And more worrisome is the fact that, in many societies, but especially in industrialised societies, the ageing trend is accompanied by declin-ing birth rates.

The Lee Kuan Yew Centre for Innovative Cities (LKYCIC) established the Lee Li Ming Programme in Ageing Urbanism in 2013 It was absolutely the right time to move into this research direction Globally, ageing was be-coming an increasing concern in search of good policies and solutions, both anticipatory and dealing with current issues Singapore’s population, that is citizens and permanent residents, aged 65 years and older is currently 13% of the resident population It is expected to reach 25% in 2030 There has been strong official interest and support for research and development to encour-age active and healthy encour-ageing, and how to better look after the less able and ageing in place.

In 2017, LKYCIC organised an international colloquium on the topic of age-ing and the built environment with focus on urban environments for healthy ageing The colloquium brought together some 100 experts, researchers, and participants interested in sharing policies and practices from various countries including Australia, Finland, Iceland, Japan, the United States, and Singapore on how they enhance and improve the lives of ageing populations Primarily the presentations covered housing, mobility, the neighbourhood environment, design, and innovation to promote active ageing There was a study focussing on how digital services could support healthy and active ageing.

Foreword

we believe the examination of policies and practices will yield conclusions that will be helpful to all societies and communities we can learn from each other and hopefully prepare better ageing futures for our population.

Chan Heng Chee Professor and Chairman, Lee Kuan Yew Center for Innovative Cities Singapore University of Technology and Design

The present volume is based on selected papers presented at, as well as activi-ties and discussions that have arisen from, the inaugural International Ageing Urbanism Colloquium, 26–27 October 2017, Singapore The colloquium was convened by Dr Belinda Yuen and supported by the Lee Li Ming Programme in Ageing Urbanism, Lee Kuan Yew Centre for Innovative Cities, Singapore Uni-versity of Technology and Design.

we are grateful to Mrs Lee Liming who made a generous gift to fund a work programme on ageing Since its inception in October 2013, and under the lead-ership of Dr Yuen, the Lee Li Ming Programme in Ageing Urbanism has sup-ported a multidisciplinary team working to enhance our understanding of older people’s appropriation and needs in the city; to develop innovative designs and solutions to meet those needs; and to disseminate theoretically rich and context- specific frameworks for action.

Particular thanks must go to all contributors who have helped to produce this snapshot of global, contemporary, and interdisciplinary research on various as-pects of urban environments and aged populations Finally, I would like to thank Freya Yu and Katherine Loh for providing valuable administrative support.

Anna P Lane January 2019

Acknowledgements

Anna P Lane

The role of urban, built environment factors in shaping healthy ageing trajecto-ries is a burgeoning area of research, policy, and practice interest Very broadly, urban areas are those with high population or building density and the term “built environment” describes buildings, including residential and commercial properties, spaces between and surrounding buildings, as well as infrastructure, such as transportation, that supports the activities and behaviours of people who interact with the environment (Giles-Corti et al., 2016) Viewed within the “Healthy Ageing” paradigm (world Health Organization [wHO], 2018), the spatial layout and design qualities of urban areas shape the conditions of daily life and act as enablers or inhibitors of human activities and behaviours that alternately promote or limit functioning, health, and quality of life for urban dwellers Consequently, how well we plan, design, and construct our homes, recreational spaces, and transportation systems has significant implications for people’s capacity to develop and maintain the functional ability that enables well-being into old age.

with accelerating rates of population ageing in most parts of the world as im-petus, globally, researchers, policymakers, practitioners, and citizens are taking action on the physical environmental determinants of health and well-being in cities and communities They are working in all manner of ways to ensure infra-structure and services are prepared for the growing number and diversity of older people who will constitute our societies (e.g Buffel, Handler, & Phillipson, 2018; Chong & Cho, 2018; wHO, 2016) Ensuring that urban environments foster healthy ageing is key among their objectives since an older population in poor health would no doubt be costly, while a healthy, enabled older population can be a significant boon for societies and economies In this volume, we aim to provide a snapshot of contemporary interdisciplinary research on this wide- ranging topic.

The present volume is based on selected papers presented at, as well as activ-ities and discussions that have arisen from, the inaugural International Ageing

AUTHOR’S NOTE: I thank Julienne Chen, Research Fellow, LYCIC, for her helpful comments on a draft version of this chapter and acknowledge Dr Belinda Yuen, Head of the Lee Li Ming Pro-gramme in Ageing Urbanism.

Urbanism Colloquium, 26–27 October 2017, Singapore The colloquium was supported by the Lee Li Ming Programme in Ageing Urbanism at the Lee Kuan Yew Centre for Innovative Cities, Singapore University of Technology and Design Dr Belinda Yuen, Programme Head, conceived of, and convened, the colloquium for the express purpose of bringing together a diverse range of in-ternational researchers, policymakers, and practitioners working on challenges at the nexus of population ageing and urbanism, and to discuss and contribute to a conversation on innovative research, policy, and practice for an age-friendly world.

In this edited volume, we have put together a set of contributions from aca-demics and practitioners on the following colloquium themes: (a) affordable and accessible housing options to support ageing in place; (b) urban environments to promote health-enhancing mobility and activity patterns; and (c) innovative planning and design strategies for inclusive and age-friendly neighbourhoods The themes map directly onto select key priority areas in Singapore’s Action Plan for Successful Ageing (Ministry of Health [MOH], 2016) This policy document articulates the government’s commitment to action that will “transform Singa-pore into an age-friendly city where SingaSinga-poreans can age-in-place gracefully and confidently” (MOH, 2016, p 63).

Included in this volume are contributions from established and emerging researchers from multiple disciplines, including gerontology, psychology, en-gineering, urban planning, and design, who are working in multiple contexts, including Asia-Pacific, Europe, and North America we hope this snapshot of contemporary research will enrich ongoing discussion on various aspects of urban environments and aged populations in such a way that influences fur-ther research, planning, and policymaking that ultimately delivers beneficial outcomes to urban citizens Additionally, we aim to highlight the importance of a more substantial consideration of older persons in city and neighbourhood planning.

while this book has many global examples of urban environment and healthy ageing linkages, there is a distinctive focus on Singapore Singapore is a sover-eign city state situated on a small island in South-eastern Asia and, by 2030, a quarter of its national population will be aged 65 years or over (MOH, 2016) In presenting examples from Singapore, we hope to bring stronger attention to-wards ageing population trends in the Asian region, where more than 50% of the global population resides (United Nations Department of Economic and Social Affairs [UNDESA], 2017b) Currently, knowledge on ageing-friendly environ-ments in high-density, Asian contexts is insufficient we hope this book will go some way in addressing this limitation and meeting the growing need for good insights from both Asian and western contexts.

In this introductory chapter, I synopsise fundamental concepts and frame-works for the study of urban environments for healthy ageing Then, I summa-rise the 11 chapters in this volume that are organised into three parts, under the following headings: Housing, Mobility and transportation, and Urban planning and design.

Socio-demographic transformation

The intersection between built environment and health and well-being for older persons is a flourishing field of study Growing interest in understanding the prospects and challenges of this intersection is largely being fuelled by two key global trends: population ageing and urbanisation Population ageing refers to the increasing share of older persons in a population, which is a symptom of the long-run decline in fertility evidenced almost everywhere in the world, and in-creased longevity within the group of high-income countries, the ageing tran-sition began later in Asia, and thus, projected growth in the older population tends to be higher in the countries of this region (Table I.1) In Singapore, for instance, a 97% increase in the population aged 60 years or over is expected between 2015 and 2030 (UNDESA, 2015, p 16) Urbanisation concerns the increase in the proportion of a population living in urban areas, and Singapore is one of the world’s most urbanised places with 100% of the population living in urban areas of the island (UNDESA, 2017b).

Projections provided by UNDESA show that, globally, the population aged 60 years or over is growing faster than all younger age groups Indeed, the total number of persons aged 60 years and above is expected to more than double by 2050, increasing from 962 million in 2015 to 2.1 billion in 2050 (UNDESA,

Table I.1 Ten countries or areas with the largest share of persons aged 60 years or over,

1Sweden22.0Japan33.4Japan42.42Norway20.2Italy29.7Spain41.93Channel

Islands 20.1 Germany 28.0 Portugal 41.7 4United

Kingdom 20.0 Portugal 27.9 Greece 41.6 5Denmark19.5Finland27.8Republic of 8Belgium18.4Greece26.5Italy40.39Switzerland18.2Slovenia26.3Singapore40.110Luxembourg 17.8Latvia26.2Poland39.5

Source: From world Population Ageing 2017 – Highlights, by UNDESA © (2017) United Nations Reprinted with the permission of the United Nations.

2017a, p 11) The number of people at very advanced ages is increasing too, with more and more people living longer, and some exceeding 100 years helped largely by innovations in medical technologies and care (Christensen, Doblham-mer, Rau & Vaupel, 2009) The global population aged 80 years or over is projected to increase threefold between 2017 and 2050, increasing from 137 million to 425 million (UNDESA, 2017a, p 7).

Although older people today are generally living longer in good health than their predecessors, they are also living more years with disability That is, the expected increase in life expectancy at birth exceeds the expected increase in healthy life (ILC – Brazil, 2015) Recent epidemiological evidence from the United Kingdom, for example, has shown that people will have a longer life expectancy, but the extra years of life will likely be accompanied by four or more chronic diseases, such as cancer, diabetes, dementia, and depression (Kingston, Robinson, Booth, Knapp, & Jagger, 2018) Given the shift in the age structure of populations across the globe, societal anxieties in many cities and communi-ties have been heightened about whether existing infrastructure and services can support and enable increasing numbers of functionally diverse older people to live with dignity, respect, and satisfaction.

Given these concerns, is it perhaps not surprising that the popular narrative on population ageing has been largely negative in sentiment, with terms such as “silver tsunami” used frequently in the media and elsewhere There is no doubt that an older society poses challenges For example, there will be fewer people of working age to drive the economy, provide needed services, and contribute to the public purse through taxation At the same time, demands on the health system are likely to rise since older people are greater consumers of health and medical care due to an increased risk with advancing age of Alzheimer’s disease and other chronic diseases (wHO, 2016) This challenge is reflected in the old-age dependency ratio, which measures the number of those old-aged above 65 years as a share of those of between 15 and 64 years, or working age Reflecting its advanced transition to an aged population, Japan in 2017 had the lowest support ratio in the world, at 2.1 (UNDESA, 2017b, p 11).

Arguably the effects of population ageing may pose greater policy challenges in ultra-dense cities, such as Singapore, which are often coupled by specific con-ditions, such as scarcity of land and unique socio-economic, cultural, and polit-ical factors (Chong, Jia, Loo, & Cho, 2015) In this book, we showcase nascent insights from research conducted in Singapore, a city state with a central plan-ning style of government and a small land mass that has placed ageing high on the national political and social agendas we aim to bring these insights along-side existing evidence from a range of other cultural and sociopolitical contexts, including those from Australia, Japan, Finland, the Netherlands, and the United States of America, for example.

Notwithstanding these challenges, positive prospects for cities and commu-nities also exist Older people are significant contributors to economy and soci-ety, and age 65 is not a threshold beyond which all people become dependent

on younger adults (Plouffe & Kalache, 2010) Older people often provide un-paid care for grandchildren and other older people, such as parents, siblings, or spouses, and they perform voluntary work and other vital tasks in their com-munities Moreover, change in traditional life stages have seen more people participating in the labour market beyond the typical age of retirement ( Martin, 2018) To combat negative rhetoric around population ageing and old age, and to shed greater light on opportunities rather than challenges associated with aged populations, the world Health Organization is championing a global campaign to combat ageism and promote more positive narratives about older people (wHO, 2016).

Socioecological models of ageing

To frame the discussion presented in this volume on the complex urban en-vironment and well-being connection, it is useful to draw upon socioecolog-ical models In particular, the wHO “Active Ageing” and “Healthy Ageing” frameworks are central to discourse on ageing, environment, and quality of life Formally, active ageing is: “the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age (…) It allows people to realize their potential for physical, social, and mental well-being throughout the life course…” (wHO, 2002, p 12) Although the concept of active ageing applies equally to other forms of activity and participation (e.g social, spiritual, and cultural), it tends to be cited less frequently outside the mobility and physical activity literature Some ageing experts have been critical about how the active ageing framework has been applied in the policy arena, where it has been used to rationalise older people’s continued labour market participation (Boudiny, 2013) More recently, a greater focus has been placed on healthy ageing: “the process of developing and maintaining the functional abil-ity that enables well-being in older age…[where] functional abilabil-ity comprises the health-related attributes that enable people to be and to do what they have rea-son to value” (wHO, 2016, p 41) Of note is that health, as it is conceptualised in these frameworks, is a holistic notion and more than the absence of disease This reorientation towards well-being represents a marked shift away from the biomedical model with its emphasis on the treatment and cure of disease It is also positive in a sense as it implies that people who live with physical, sensory, and cognitive limitations or disabilities have the capacity to realise well-being and to do those things that they value.

The healthy ageing framework assumes a lifespan perceptive on human devel-opment (Baltes, 1987; Baltes, Lindenberger, & Staudinger, 1998) Accordingly, contemporary approaches in the field of public health emphasise investments at all stages of the life course, including late life, to optimise lifetime health tra-jectories, such that well-being is enhanced and ill-health or disability is avoided, delayed, or, alternatively, accommodated through personal and environmental adaptations.

Functional capacity across the life span

Humans are complex beings and people lead complex lives, thus individual ex-periences of ageing are not uniform and the older population is highly heter-ogeneous As people age, they become increasing different from one another when people reach the later stage of their life span, they do so with a unique combination of capacities as determined by the cumulative effects of earlier life experiences, major life events, and exposures to a broad array of bio, psycho, social, and environmental factors (Beard & Bloom, 2015) The relative and total contributions of these innate and contextual influences vary for different aspects of development (e.g cognitive, physical, and social) and for different points in the lifespan It is generally accepted that the potential contribution of supportive environmental factors for optimal functioning become increasingly important during the late part of the life span since intrinsic capacities, in general, tend to exhibit a downward trajectory beginning in adulthood (Figure I.1) The general trajectory of early life growth and later life decline is illustrated in the oft-cited

Rehabilitation and ensuringthe quality of life

*Changes in the environment can lower the disability threshold, thus decreasing the number of disabled people in a given community.

Growth and

development Maintaining highestpossible level of function Maintaining independenceand preventing disability

Figure 1 Maintaining functional capacity over the life course

Figure I.1 Life span approach to ageing.

Source: (ILC – Brazil, 2015, p.43; Adapted from Kalache & Kickbusch, 1997 and wHO, 2002) Used with permission.

Although developmental trajectories vary considerably between people, in general and beginning from mid- to late life, most people tend to experience age-associated losses in cognitive (e.g memory, speed of information processing, visual-spatial ability), sensory (e.g hearing and vision), physical (e.g balance, gait), and social (e.g number of social connections and size of social network)

domains of functioning There is considerable within-person and between- person differences in both the timing (onset) and rate of these changes such that some individuals show stability of some types of behaviour, declines in others, and improvements in others (Hoyer & Roodin, 2003) It is useful to note the term “age-associated change” is used since chronological age does not directly cause change Rather, it is the specific processes or events that occur during an interval of time that are the real determinants of development (Hoyer & Roodin, 2003).

As revealed in Figure I.1, a fundamental question for those who take a life span view of ageing is: how can developmental trajectories be optimised, and how can functioning, and thus quality of life in old age be promoted and maintained?

Here, it is appropriate to emphasise that old age is not solely a time of decline Indeed, empirical evidence has shown that older adults exhibit gains or better performances for some life tasks than younger adults For example, older people may have fewer friends or acquaintances, but the quality of the friendships they retain is relatively high and are a core source of instrumental and emotional support (Charles & Carstensen, 2010) Older people may take longer to per-form complex cognitive tasks due to declines in inper-formation processing speed and executive function (Glisky, 2007), but they are more effective than young adults when solving everyday problems, especially interpersonal problems, be-cause they are better able to regulate emotions (Blanchard-Fields, 2007) Nev-ertheless, during later life and in general, people experience age-related decline in many intrinsic capacities that are essential to performing everyday tasks and activities, and thus fundamental for personal autonomy and independent living For some people, and over time, their intrinsic capacity may become impaired and they may become increasingly dependent on external or environmental supports (Figure I.1) Increased risk and prevalence with age of chronic health conditions and injury also contribute significantly to increased rates of disabil-ity among older persons This is exemplified in statistics provided by UNDESA that show more than 46% of persons aged 60 years or over have disabilities, and over “250 million older people experience moderate to severe disability” (UNDESA, n.d.).

Putting healthy ageing into urban planning and design

Physical and social environmental conditions may exacerbate existing decre-ments in intrinsic capacity, thereby reducing the physical and subjective mani-festations of well-being Alternatively, supportive environmental conditions may alleviate or compensate for decrements in intrinsic capacity and promote, or at least maintain, levels of well-being For instance, the outdoor mobility of an older person with arthritic knees who resides in a housing estate situated in a hilly environment with many stairs, may be restricted In turn, the older person may become homebound and social isolated, and experience feelings of loneli-ness However, supportive handrails built along stairs may lessen the physical barrier that the stairs pose, and better enable the older person to move about

their neighbourhood, thereby supporting opportunities for physical, social, and mental health Likewise, supportive neighbours might assist with outdoor mo-bility and navigation.

The notion of adaptation, and specifically adaptation of the physical en-vironment, and adaptation to individual changes in intrinsic capabilities, was theorised by Lawton and Nahemow (1973; Lawton, 1983) The model of “person- environment fit” or “competence-press” posits that the performance of, and comfort with, daily activities is possible when there is a good fit or congru-ence between the individual’s unique competencies and the demands of their en-vironment, whereas maladaptive behaviour may result when there is a mismatch between personal competence and environmental demands This model explains how older people are able to maintain autonomy, independence, and a sense of well-being by lowering the physical demands of their immediate surroundings to suit their abilities For example, to lower the demands of the physical environ-ment to achieve mobility independence, an older adult may use a walking stick as a support or choose to walk along the routes that they perceive as safe or that have more benches where they can stop to rest when they feel fatigued Or, envi-ronmental pressure may be lowered by ensuring that footpaths are non-slip, flat, and even, and that people have access to alternative routes between destinations in a locale Logically, modifications to the physical environment would have wider population level impacts than interventions to change individual behav-iour Moreover, environment-led changes to individual behaviour may be more sustainable over the long term Consequently, for public health, it is of interest to understand how city and neighbourhood contexts aid or impede people’s daily activities, and to plan and design urban areas accordingly.

Thus, one possible answer to the question – how can functioning and thus quality of life in old age be improved or maintained? – lies with those who plan and create urban areas and thus have greater scope and capacity than do individ-uals, to shape the conditions in which people act out their daily lives.

wHO framework for healthy ageing explicitly identifies environmental char-acteristics as determinants of functional ability:

Functional ability is made up of the intrinsic capacity of the individual, rel-evant environmental characteristics and the interaction between them (…) Being able to live in environments that support and maintain your intrinsic capacity and functional ability is key to Healthy Ageing.

(wHO, 2018)

Additionally, the framework underscores opportunities to intervene for health and well-being at the level of the built environment In doing so, it endorses ac-tions by policymakers, urban planners, architects, and designers, among others, to create, build, and facilitate housing, recreational spaces, and amenities that older residents value and need to manage the various changes they experience in their intrinsic capacity with ageing.

Socioecological models of healthy ageing view humans as being embedded within successively larger social and physical systems (see “health map for a lo-cal human habitat” in Barton & Grant, 2006) Thus, to improve health and well- being in aged populations, health promotion must logically focus on the multiple- level factors that influence specific individual behaviours, or interact with specific human competencies that are essential for healthy ageing For ex-ample, through provision of local amenities, wide footpaths, and comfortable seating along walking routes, older people may be encouraged and supported to walk more frequently and for longer durations This walking activity may, in turn, lead to the increased frequency of social interaction with others, and may be done at such an intensity that physical health benefits accrue to the older walker, which would ultimately be reflected at the population level by the re-duced prevalence of depression and diabetes.

In effect, responsibility for public health lies with individuals, health depart-ments, and beyond; “health is everyone’s business” (United Nations Global Compact, n.d.) As urban planners, architects, and designers have considerate influence over the built environment, they have a role to play in shaping opti-mal trajectories of healthy ageing and promoting public health (Seidel, Kim, & Tanaka, 2012) Arguably, this health role of urban planners, architects, and de-signers is amplified in highly urbanised cities, including Singapore we hope the book will spur meaningful discussions at the intersection of urban design and environment, and its impact on the health and well-being of older people in our cities and communities.

Structure of this book

Chapters in this volume are organised into three major parts: Part I – Housing; Part II – Mobility and transportation and Part III – Urban planning and de-sign Chapters within each thematic part range from collating, synthesising, and reviewing existing evidence to presenting new evidence from recent empirical study The chapters not only summarise the existing knowledge in each of these general themes, but also point to areas of opportunity where we may do more to improve our understanding Each of the three parts includes a chapter focussed on Singapore.

Part I – Housing

Part I revisits the literature and debates on the intersections between the person, their housing, and aged care services Evidence suggests that most people, in many parts of the world, wish to remain living in their own homes for as long as reasonably possible and in a location of their choosing (Beer & Faulkner, 2011; wHO, 2016) For many people, this location is the community where they have lived for many years, raised children, established friendships and sup-port networks, and constructed a life history It represents a place to which they

feel emotionally attached and invested, perhaps through home ownership or involvement in local activities and community organisations It has also been argued that long-term residents develop a physical attachment to their place of residence and, through years of lived experiences, they develop a sophisticated spatial knowledge that aids in navigation and promotes a sense of personal con-trol and autonomy (Lawton, 1983; Rowles, 1978) For other people, especially those in reasonably good health, this location may be somewhere new and aspi-rational It may be a location which offers a particular retirement lifestyle, such as a relaxed coastal location or, alternatively, inner city apartment living where there is a density of amenities and people Ageing in place therefore emphasises choice in housing decisions and, by extension, has implications for social- and health-care provision.

while the desire to age in place appears universal, the strategies to achieve this goal and the challenges encountered by multiple stakeholders have varied by na-tional and cultural contexts In Part I we outline some experiences with ageing in place and housing with care in Australia, Singapore, and Japan.

In Chapter 1, Julie Byles describes a fundamental life decision that older Australians make with regard to their housing situation and aged care, that is, to stay in their family home or move to other accommodations that may be better suited to their current and expected needs She draws on data from two large Australian studies of older persons housing to describe the transitions that older people experience, or expect to experience, as they age, and the connection with aged care service usage In Chapter 2, Belinda Yuen focusses her discussion on the suitability of the physical home environment as perceived by older people in Singapore She presents findings from an empirical investigation of the living situations of a sample of older adults residing in high-rise apartments in public housing estates She discusses their moving intentions, housing preferences, and perceptions of housing quality, and draws some insights for future housing pol-icy in Singapore.

In Chapter 3, Satoshi Kose draws upon his extensive knowledge of housing policy in Japan, as well as his first-hand experience in developing dwelling design guidelines for an ageing society He provides a detailed account of successive waves of initiatives to bring affordable and accessible housing to increasing num-bers of older people His account draws attention to concomitant issues such as incentives for age-friendly modifications in private-sector rental housing, and building a community-based integrated care system He argues integration and coordination of policies between the ministries responsible for health and con-struction are critical if ageing in place is to be realised.

Part II – Mobility and transportation

Being physically active in old age is associated with a range of health benefits Older adults who engage in recommended levels of physical activity can achieve increased cardiovascular fitness, increased muscle strength and flexibility, im-proved joint mobility, weight management, and decreased stress levels (wHO,

2016) These physical activity-related health benefits, in turn, reduce the risk of falling and consequent hospitalisation due to injury Moreover, since cardio-vascular disease, diabetes, and stress are risk factors for cognitive decline, phys-ical activity may be useful in maintaining or delaying the decline of cognitive function and the onset of Alzheimer’s disease and other dementias (Hertzog, Kramer, wilson, & Lindenberger, 2009) In many countries, the prevalence of health- enhancing levels of physical activity in older adults is considered low (wHO, 2016) Given the associations between physical activity and health and well- being, there are calls from public health and urban planning experts to pro-mote physical activity through built, as well as social environmental approaches In Chapter 4, Ester Cerin, Andrea Nathan, Jelle Van Cauwenberg, and Anthony Barnett take a public health perspective to the important links be-tween physical activity and health, and emphasise the identification of factors that can positively affect participation by older people at a population level They present a critical synthesis of findings from published empirical studies on neighbourhood physical environmental correlates of total, leisure-time, and transportation physical activity in older adults.

The concept of life-space mobility refers to the spatial area in which an in-dividual moves purposefully and reflects access to amenities and opportunities for social participation Evidence suggests that increasing older adults’ life-space mobility has beneficial health and well-being outcomes (Rantakokko, Portegijs, Viljanen, Iwarsson, & Rantanen, 2013) It is towards this concept that Chapter 5 by Erja Portegijs and Tania Rantanen is oriented For current older cohorts with mobility disability, interventions are needed to improve opportunities for active ageing and meaningful participation The authors present findings from a study in Finland that was conducted with the aim to expand life-space of older prac-tically homebound people with mobility limitations They summarise evidence that suggests compensating for reduced individual capacities through provision of external supports or environmental modification may improve opportunities for participation.

The focus in chapters 6 and 7 turns to transportation infrastructure and mo-bility Older people rely on various modes of transport such as walking, cycling, buses, trains, and cars to move between home, work, the supermarket, health-care facilities, recreational facilities, and so on Thus, transportation options influence people’s perceived and actual capacity to access finance, food, care, leisure-time activities, from which they derive good health and well-being In Chapter 6, Gudmundur Ulfarsson and Sungyop Kim present a contemporary, evidence-based discussion of safe transportation mobility for older adults and how it affects their quality of life Also, they provide a balanced perspective on the emotive issue of older drivers and traffic safety In Chapter 7, Yuting Hou and Adithi Moogoor draw upon data from the Land Transport Authority, Singapore, to map older persons’ travel behaviour and geography They present novel insights for local transportation policymakers, by isolating “transport- disadvantaged” neighbourhoods, where older people are highly reliant on pri-vate vehicles, and identifying trip destination hotspots.

Part III – Urban planning and design

This thematic part includes contributions from urban planners, architects, and designers who are working to advance innovation on urban environments and technologies for healthy and active ageing.

The residential neighbourhood is considered a particularly salient urban scale for older people as they tend to spend a greater proportion of their daily lives in and around their homes (Buffel et al., 2012) This is due in part to mobility limitations that arise from declines in physical functioning and reduced driving ability Retirement from paid work and the take-up of new roles as family car-egivers or community volunteers represent other reasons why older people may spend more hours in their day at or near their home Younger adults by com-parison are likely to travel more frequently outside their immediate residential neighbourhood, and to spend more hours in the day at a place outside the home, such as the workplace As older adults spend relatively more time in their imme-diate residential area than do younger adults, they are more likely to be impacted by their experiences and exposures to social and physical aspects in that setting (Buffel et al., 2012).

In Chapter 8, Chanam Lee and Sinan Zhong discuss existing empirical ev-idence on age-friendly communities They present built and social elements of age-friendly communities at the neighbourhood and site level with real-world models drawn from best practice case examples and discuss to what extent ex-isting studies consider the interaction between person and environment, high-lighting knowledge gaps to be addressed in future studies The authors bring attention to the benefits of intergenerational activities in promoting active age-ing and in creatage-ing age-friendly community In Chapter 9, Dr Gillian McFeat Lin proffers some recommended design strategies for an inclusive neighbour-hood She presents insights from a review of planning guidelines, standards of neighbourhood design, and case studies, sourced from Singapore and abroad.

In Chapter 10, discussion turns to graphic design and urban legibility Joshua Comaroff argues that greater inclusivity of older city-dwelling adults, particu-larly those with sensory (vision) difficulties, may be aided by controlling the clar-ity and hierarchy of information within subsets of cclar-ity public spaces He presents the case of urban Singapore as an example in which many well-maintained public spaces and housing estates are nonetheless confusing for older adults.

In the final chapter, Chapter 11, Yuan Lu, Rens Brankaert, Carlijn Valk, Mar-jolein den Haan, and Xipei Ren draw attention to the role of digital technol-ogy design in fostering opportunities for active ageing in urban environments The authors present two case studies conducted in the Netherlands that concern the design of digital services to support older adults to access public transport Through the case studies, they demonstrate how design strategies related to technology acceptance, technology adoption, and multi-stakeholder collabora-tion can contribute to greater transportacollabora-tion accessibility and ultimately greater outdoor mobility among older adults, with obvious implications for healthy and active ageing.

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Part I

Housing

1 Housing for older

Australia is known for high rates of home ownership, with the home sitting at the heart of family life, and the “great Australian dream” being to own a free- standing single family suburban home on a large block of land, with drive-in access to a garage for the family cars (willing & Pojani, 2017) This ideal has been particularly true for the current generation of people over 65 years of age who mostly live in such dwellings free of mortgage or other financial liability, and who own a large share of Australia’s total housing wealth (Productivity Commis-sion, 2015) However, this landscape is rapidly changing, with a rise in apartment dwellings, particularly in major cities The housing economy is also changing with rising house prices, more people owing mortgages on their houses, and an increasing rental market There is a strong social and political expectation that older people should move out of their homes to free up housing stock for younger people in the context of diminishing housing affordability (Judd, Liu, Easthope, Davy, & Bridge, 2014) However, these choices are not so clear from the perspec-tive of the older person, whose home may hold a lifetime of meaning, and who may not have so many choices in terms of affordable housing alternatives.

As they age, people face a watershed decision whether to stay in their own homes, where they have lived for most of their lives, or whether to move into other accommodation that may be more appropriate to their changing needs and family structure If they stay in their historical home, they may need to make changes to the dwelling to provide better supports for mobility and other activities of daily living If they move, they may be able to “downsize” to an apartment or smaller dwelling, realise capital in their home, and enable better access to aged care and support “To stay, or to move?” therefore becomes a conundrum in later life.

In this chapter, we look at housing for older people in Australia, consider-ing their changconsider-ing needs, dwellconsider-ing types, and the intersections between hous-ing and aged care we draw on two large Australian studies of older people’s

AUTHOR’S NOTE The Home and Independent Living Study (HAIL) was funded by Ageing Disability and Home Care, in the NSw Department of Human Services HAIL is a substudy of the Sax Institute 45 and Up Study, https://www.saxinstitute.org.au/our-work/45-up-study/ The Australian Longitudinal Study on women’s Health (ALSwH), http://www.alswh.org.au, is funded by the Australian Department of Health.