Age-friendly cities and environments: an investigation of the living environment of older people in England based on the MRC Cognitive Function and Ageing Study II

Abstract

BackgroundWith trends in population ageing, the idea of age-friendly cities has been proposed with a focus on built and social environmental features related to active ageing. We aimed to describe the living environment of older people at small area level using data from the Cognitive Function and Ageing Study II (CFAS II), a representative sample of 7505 people aged 65 years and over in England. MethodsLiving environment was described at the community and street level. At community level, postcodes of the CFAS II participants were mapped onto 557 Lower Layer Super Output Areas and linked to environmental data in Neighbourhoods Statistics including area deprivation, crime, distance to services, land use, and green space. Street level assessment was based on an observational instrument designed for UK postcodes, the Residential Environmental Assessment Tool, by use of visual streetscape images of Google Street View. The measurement method was validated and showed acceptable intermethod reliability of physical and visual image audits. Three rural and urban categories (urban conurbation, urban city and town, rural areas) were defined by the 2011 rural–urban classification. FindingsTwo-thirds (n=4905) of the older population lived in an urban conurbation. More of the younger old (aged 65–79 years) than older old (≥80 years) lived in rural areas (1158 vs 396). In the overall population, we found moderate associations between area deprivation and crime (Spearman correlation=0·6), distance to services (−0·2), land use mix (0·5), and green space (−0·3), but they were weaker in rural areas. In addition to rural–urban and area deprivation differences, substantial variations in built and social environmental features were found at community and street levels: communities in urban conurbations generally had high crime, shorter distance to services, high heterogeneity of land use, and low proportion of green space with worse quality of street level conditions than did communities in rural areas. InterpretationOlder people in England live in a wide variety of environments with potential effect on health and wellbeing. Use of new technology can help to observe and explore variations in living environments at the small area level systematically and comprehensively; this provides opportunities to identify important environmental features related to healthy ageing and develop practical guidelines for policy planning to create age-friendly cities and environments through an evidence-based approach. FundingThere is no specific funding contributing to this study. Medical Research Council Cognitive Function and Ageing Study II (MRC CFAS II) was funded by the Medical Research Council (grant number G0601022).