Gustavo Betini is a PhD student in the School of Public Health Systems, University of Waterloo. Mr Betini has PhD in Ecology and large experience using a number of quantitative tools to investigate how changes in land use and climate change impact species interactions and the resilience of populations. He is now interested in understanding how these same environmental changes impact mental health.
A person-centered approach to age-friendly cities in Canada
Gustavo S. Betini, University of Waterloo, Canada
Andrea Kovacs, Andrew Anthony Faller-Saunders, John Hirdes, University of Waterloo, Canada.
Population aging is expected to double the number of people over age 60 by 2050 creating new concerns and demands from policy-makers in order to address the needs of older people and improve their quality of life. As a response to this transition in demographics, the World Health Organization has developed and provided checklists for communities to adapt policies, services, and structures related to the physical and social environment. The rationale behind these ‘age-friendly’ initiatives comes from a more holistic view that recognizes aging as a process that involves physiological, behavioural, social, and environmental changes that happens at the individual and community levels. In line with this concept, the World Health Organization identified eight domains related to the build environment that need to be adapted for cities to become age friendly. However, a large sense of belonging to the community comes from how the older population perceives their environment, which might not be well represented in these eight domains. The goal of this study is to use a person-centered assessment system developed to understand the needs, strengths, and preferences of vulnerable older adults and identify the most age-friendly cities in Canada.
To investigate how older adults perceive their environment, we used the interRAI home care assessment (RAI-Home Care), a standardized instrument focuses on the person’s functioning and quality of life. The RAI-Home Care is used for adults in home and community-based settings. Most of its clients are the frail elderly or persons with disabilities who receives or wants to receive some formal health care and/or supportive services. For this study, we used assessment completed by clients who were over 60. To rank each public health unit, we selected 6 questions for the RAI-Home Care assessment that indicates how safe and lonely they feel, whether or not they go outside, access to their home, whether they have conflicts with family and friends, and economic-trade-offs to make ends meet. We then ranked public health units according to the percentage of answers that indicate positive feelings about their environment.
We obtained information from 138,423 unique individuals for 322,039 assessments conducted in 57 public health units in 6 Provinces and 1 Territory in Canada. Exploratory analysis indicate large variation among the health units with British Columbia and Yukon scoring the lowest rates. As a next step, we are are developing a broader quality indicator that also includes questions about the general health of each client with the goal of characterizing the quality of life of older adults across Canada and expand the analysis to other countries that also use the RAI-Home Care assessment. We will also include analysis by forward sortation area, which will allow us to rank large cities. This new tool will provide a quantitative way to assess how older adults perceive their environment and provide guides for cities to evaluate the success of the implementation of their age-friendly initiatives.