Developing robust indicators of age-friendly neighborhood environments across urban-rural and socioeconomic gradients in 20 countries from five continents

Abstract

BACKGROUND AND AIM: By 2050, the older-adult population (60+) will reach 2.1 billion, surging fastest in low- and middle-income countries (LMIC). In response, the World Health Organization (WHO) has developed a framework and indicators of age-friendly urban environments, but these criteria have been challenging to apply in rural areas and LMIC. This study fills this gap by adapting these indicators to such settings and assessing variation by country-level income and community-level urban-rural status. METHODS: First, a narrative review identified and described existing healthy-aging audit tools. Next, data were drawn from the Prospective Urban and Rural Epidemiology (PURE) study’s environmental-exposure assessment tools, which relied on systematic social observation and ecometrics to develop objective and subjective indicators relevant to cardiovascular disease. Following a multitrait, multimethod (MTMM) approach to assess convergent and discriminant validity, we specified a set of 23 indicators aligned with WHO’s framework and calculated their values across 496 communities in 20 countries, including 382 communities (77%) located in LMIC. RESULTS:Among the WHO’s eight environmental domains, six were represented in PURE’s environmental data. Overall, 91% of communities had access to parks/recreation and street lighting, while 45% had traffic lights. In addition, 85% of communities offered a public medical clinic, but only 15% a public hospital. Communities in high-income countries rated highest overall, although bus-transit connections were most common in low-income countries (95%). The greatest amount of variation by urbanness was seen in the number of streetscape-greenery elements (55.2 in rural areas vs. 32.5 in urban); traffic lights (17.8% vs. 67.1%); access to universities (32.9% vs. 90.3%); and home-internet availability (24.7% vs. 53.8%). CONCLUSIONS:This study indicates the extent to which environmental supports for healthy aging may be less readily available to older adults residing in rural areas and LMIC, highlighting a critical aspect of equity that is increasingly important to address in an aging world. KEYWORDS: Green space, Walkability, Healthy aging, Methodological study design, International collaboration