Louise Lafortune is a Senior Research Associate in the Public Health and Ageing Research Unit, University of Cambridge, UK. Her expertise includes evidence reviews, priority setting partnership activities, and research that focuses on the development and evaluation of preventive interventions for frail older adults and people affected by dementia. She is co-investigator on the UK National Evaluation of Dementia Friendly Communities Study (DEMCOM) and leads a project on Frailty and Care Trajectories which harnesses routinely collected data across care settings. She has recently co-led a pilot study to test an age-friendly cities evaluation tool and led the study commissioned by the Centre for Ageing Better to assess the needs and develop evaluation and monitoring resources for members of the UK Network of Age-Friendly Cities.
Practice considerations for age-friendly community evaluations: The utility of existing tools and guidelines
The Age-friendly Cities and Communities (AFC) movement was born as a reaction to the increasing urbanisation and ageing of the global population. Evaluation of AFC initiatives is an essential element in assessing their success, but the expertise and resources to conduct evaluations is lacking in many practice settings. Tools and guidance for evaluating AFCs have been developed by the World Health Organisation and others. However, methods of assessing the structures and processes that shape the context in which AFCs are situated have been lacking, and the practical utility of existing evaluation tools remains unexplored.
Building on the insights we gained while developing an AFCs evaluation tool, this paper presents findings from a review of AFC tools and guidance conducted in collaboration with the Centre for Ageing Better to support the UK Network of AFCs. The scoping review was carried out (9-10 Sept 2017) using the search term “age-friendly” across multiple scientific literature databases, as well as web-based resources to identify the grey literature. This resulted in 234 reports for the grey and 449 titles for the academic literature. Titles, abstracts and summaries were screened and selected by two researchers, with any disputes regarding which were evaluation tools or guidance resolved by discussion. Thirty-two titles were selected from the grey literature and 15 from the academic literature, giving a total of 50 reports. Our descriptive analysis reveals that many of the tools were structured around the World Health Organisation guidance and indicators, and provide broad and useful direction for cities and communities wishing to evaluate their work. Much of this guidance however lacks the specific, practical details needed to define an evaluation question, choose an evaluation design, and identify a set of indicators, metrics, and potential data sources. All these decisions should be based on the recognition that evaluative opportunities evolve in tandem with the evolution of interventions and the context in which they are embedded – a consideration absent from many available guidance.
This paper discusses how framing AFC initiatives as “complex interventions” may help organize the diverse pieces of the jigsaw in a comprehensive framework to assess the evaluability of AFCs initiatives (or components thereof) in context and according to their developmental stage. It also present practical solutions to develop capacity and capability for evaluation of AFCs initiatives in local community and public health systems.