Assessing Age-Friendly Community Initiatives: Developing a Novel Survey Tool for Assessment and Evaluation.

BACKGROUND AND OBJECTIVES: Age-Friendly Community Initiatives (AFCIs) have gained recognition as essential responses to the needs of aging populations. Despite their growing significance, there is a notable lack of effective measurement tools to assess the planning, implementation, and sustainability of AFCIs. The purpose of this study was to develop and validate a survey tool for evaluating AFCIs. RESEARCH DESIGN AND METHODS: A sequential exploratory mixed-method design was used in two phases. First, we identified key themes from interviews with AFCI leads to generate AFCI survey items and regional workshops. Then, we conducted a pilot of the survey and assessed its measurement properties. RESULTS: Thematic analysis of interviews with 68 key informants from 58 AFCIs revealed four main themes: AFCI priorities, enablers, challenges, and benefits. These themes, combined with feedback from AFCI stakeholders at the regional workshops and a AFCI conference, informed the development and refinement of a reliable and valid AFCI survey in 2019, supported by a high Cronbach's Alpha value (α = 0.881). Steps were identified to maintain and sustain the AFCI survey over time. DISCUSSION AND IMPLICATIONS: The survey accommodates AFCIs' diverse demographics, governance structures, and priorities with a standardized and flexible approach for effective measurement. This research contributes to the academic understanding of AFCIs and aids community leaders and policymakers in planning, implementing, and evaluating AFCIs.

The impact of loneliness and social isolation on the benefits of an exercise program with hospitalised older adults.

OBJECTIVES: This study aimed to assess the prevalence and impact of loneliness (De Jong Gierveld scale) and isolation (Lubben scale) on the effects of a hospital-based exercise programme. DESIGN: Secondary analysis of a randomised clinical trial. SETTING: Acute Geriatric Unit of a tertiary hospital in Spain. PARTICIPANTS: 103 hospitalised older adults. INTERVENTION: Individualised multicomponent exercise program (20-minute sessions twice a day for 3 consecutive days). RESULTS: Among the 103 randomised patients included in the analysis (both arms included), 58.3% were male, and their mean age was 87.3 (4.5) years. According to the Lubben scale, 15.8% of patients were at risk of isolation, while 62.7% were in a situation of severe or moderate loneliness according to the De Jong Gierveld scale. In the non-isolated group, training showed a substantial positive impact on Geriatric Depression Scale (B = -1.25, 95% CI = -0.24 to -0.27). In the isolated group, all outcomes improved, but only the Quality of Life showed significant changes (B = 35, 95% CI = 4.96-35.8). The SPPB test (B = 1.62, 95% CI = 0.19-3.04) and Quality of Life, (B = 17.1, 95% CI = 1.84-32.3) showed a significant improvement in the non-loneliness exercise group while no differences were found in the loneliness group. CONCLUSION: Despite the high prevalence of loneliness and social isolation, individualised exercise programs provide significant benefits to hospitalised patients, especially in quality of life.

Examining dynamic developmental trends: the interrelationship between age-friendly environments and healthy aging in the Chinese population-evidence from China Health and Retirement Longitudinal Study, 2011-2018.

BACKGROUND: The objective of this research is to investigate the dynamic developmental trends between Age-Friendly Environments (AFE) and healthy aging in the Chinese population. METHODS: This study focused on a sample of 11,770 participants from the CHARLS and utilized the ATHLOS Healthy Aging Index to assess the level of healthy aging among the Chinese population. Linear mixed model (LMM) was used to explore the relationship between AFE and healthy aging. Furthermore, a cross-lagged panel model (CLPM) and a random-intercept cross-lagged panel model (RI-CLPM) were used to examine the dynamic developmental trends of healthy aging, taking into account both Between-Person effects and Within-Person effects. RESULTS: The results from LMM showed a positive correlation between AFE and healthy aging (ß = 0.087, p < 0.001). There was a positive interaction between the geographic distribution and AFE (central region * AFE: ß = 0.031, p = 0.038; eastern region * AFE: ß = 0.048, p = 0.003). In CLPM and RI-CLPM, the positive effect of healthy aging on AFE is a type of Between-Person effects (ß ranges from 0.147 to 0.159, p < 0.001), while the positive effect of AFE on healthy aging is Within-Person effects (ß ranges from 0.021 to 0.024, p = 0.004). CONCLUSION: Firstly, individuals with high levels of healthy aging are more inclined to actively participate in the development of appropriate AFE compared to those with low levels of healthy aging. Furthermore, by encouraging and guiding individuals to engage in activities that contribute to building appropriate AFE, can elevate their AFE levels beyond the previous average level, thereby improving their future healthy aging levels. Lastly, addressing vulnerable groups by reducing disparities and meeting their health needs effectively is crucial for fostering healthy aging in these populations.

How environments can promote active aging: results from a case study of two municipalities in Quebec, Canada.

OBJECTIVES: To address global aging, a paradigm shift is needed from disease prevention and treatment towards active aging, i.e., optimizing opportunities for health, participation, and security as people age. Little is known about how age-friendly environments promote active aging. This study thus aimed to explore how (through which mechanisms and in what contexts) environments can promote active aging and, specifically, positive health, social participation, and health equity. METHODS: Using a realist approach and semi-structured focus groups, a case study was used in two Quebec municipalities known for best fostering active aging. Data also included participants' logbooks, sociodemographic questionnaires, municipalities' sociodemographic profiles, and policy documents. A conceptual framework and thematic content analysis were carried out. RESULTS: A total of 24 participants (9 older adults, 4 health professionals, 3 community-based actors, 5 municipal employees, and 3 elected officials) took part in 5 focus groups. Regarding contexts, both cases were midsize municipalities having an income and education level higher to Quebec's averages with supportive active aging policies. Two main themes explained how the environments promoted active aging: (1) by ensuring proximity through built (urban planning), social (network structures), services (variety and availability of local and outreach resources), and organizational (active listening to older adults' needs for active aging) environments; and (2) by fostering transversality through built (universal accessibility, intergenerational spaces), social (intergenerational opportunities for social participation), and political/organizational (unified and complementary policies) environments. CONCLUSION: To better promote active aging through age-friendly environments, practices should focus on fostering proximity and transversality, and act simultaneously on multiple environments.

RéSUMé: OBJECTIFS: Pour faire face au vieillissement des populations, un changement de paradigme est requis allant de la prévention et du traitement de la maladie vers la promotion d'un vieillissement actif, c.-à.-d. l'optimisation des possibilités de bonne santé, de participation sociale et de sécurité pendant l'avancement de l'âge. Peu d'informations renseignent sur comment les environnements favorisent le vieillissement actif. Cette étude visait donc à explorer comment (par quels mécanismes et dans quels contextes) les environnements favorisent le vieillissement actif et, spécifiquement, la santé positive, la participation sociale et l'équité en santé des aînés. MéTHODES: Selon une approche réaliste et des groupes de discussion semi-dirigés, une étude de cas multiples a été réalisée dans deux municipalités québécoises, reconnues pour favoriser un vieillissement actif. Les données incluaient aussi les journaux de bord et les questionnaires sociodémographiques des participants ainsi que les profils sociodémographiques des municipalités et leurs politiques municipales. Les données ont été traitées à l'aide d'un cadre conceptuel et d'une analyse de contenu thématique. RéSULTATS: Un total de 24 participants (9 aînés âgés de 65 ans ou plus, 4 professionnels de la santé, 3 acteurs communautaires, 5 employés municipaux et 3 élus) ont pris part à un des cinq groupes de discussion. Concernant les éléments de contexte, les deux municipalités étaient de taille moyenne et présentaient des revenus et un niveau de scolarité supérieurs à la moyenne québécoise ainsi que des politiques municipales favorisant un vieillissement actif. Deux thèmes principaux expliquaient comment les environnements favorisaient le vieillissement actif : 1) en assurant la proximité des environnements bâti (aménagement urbain), social (structures des réseaux sociaux), des services (ressources locales et de proximité) et politique/organisationnel (écoute active des besoins des aînés pour un vieillissement actif); et 2) en favorisant la transversalité des environnements bâti (accessibilité universelle, espaces intergénérationnels), social (opportunités intergénérationnelles) et politique/organisationnel (politiques unifiées et complémentaires). CONCLUSION: Pour mieux promouvoir le vieillissement actif grâce à des environnements conviviaux aux aînés, les pratiques doivent privilégier la proximité et les approches transversales, en plus d'agir sur plusieurs environnements simultanément.

Measuring Age-Friendliness of Transportation and Mobility Characteristics in Communities: A Scoping Review.

BACKGROUND AND OBJECTIVES: Age-friendly communities are those with characteristics that can support and promote healthy aging. Among the common domains of these characteristics, transportation and neighborhood spaces are particularly relevant for older adults maintaining mobility in their communities. The objective of this scoping review is to provide a synthesis of age-friendly community indicators, developed for research and planning, that evaluate characteristics most associated with community-level mobility, specifically transportation and neighborhood spaces. RESEARCH DESIGN AND METHODS: We conducted a systematic search of PubMed, Scopus, Medline, APA PsychInfo, CINAHL Plus, SocIndex, Academic Search Premier, and Web of Science. We reviewed 8 articles and reports that described the development or evaluation of a set of generalizable indicators to measure the age-friendliness of a community's transportation and neighborhood spaces resources. RESULTS: Indicators of transportation and neighborhood spaces ranged from self-reported measures of accessibility and convenience to objective measures of the availability and cost of services. Explicit discussion of mobility at the community level was variable in these records, and few authors specifically discussed common life transitions impacted by these age-friendly community indicators, such as driving cessation. DISCUSSION AND IMPLICATIONS: Although age-friendly communities are a well-established goal for promoting healthy aging, our review found few validated approaches for measuring age-friendliness that researchers and communities can use to investigate mobility at the community level. This is an important gap in studying life transitions such as driving cessation. Further research can provide a better understanding of which community characteristics support ongoing mobility.

Theorizing "Place" in Aging in Place: The Need for Territorial and Relational Perspectives.

This paper argues for a greater theorization of "place" within aging-in-place research. It extends calls for a relational conceptualization of place by demonstrating the need for aging-in-place researchers to also pay greater attention to territorial aspects of place. This complementary understanding will help establish a new spatial grammar within aging-in-place research, that not only would improve conceptual clarity to aging in place, but would also support a more critical engagement of aging in place in questions of inequality. The paper demonstrates this through a discussion of 2 forms of inequality pertinent to older people: the uneven capacity of places to support older people and experiences of social exclusion in relation to place attachment for older people from marginalized groups.

A Meta-Analysis on the Influence of Age-Friendly Environments on Older Adults' Physical and Mental Well-Being.

The importance of age-friendly environments (AFEs) for older adults has been empirically and theoretically highlighted by the extant literature. However, the strength of the association between environments and older adults' well-being has not been comprehensively quantified. Given the different attributes of the physical and mental dimensions, this meta-analysis aims to synthesise and quantify the association between AFEs and the physical and mental well-being of older adults. Fourteen eligible studies were included in this analysis: among which eight explored the link between AFEs and physical well-being, and eleven investigated AFEs in association with mental well-being. A random-effects model showed a small but significant correlation between AFEs and the mental well-being of older adults (r = 0.160, 95% CI [0.084, 0.224], p < 0.001), and the correlation between AFEs and physical well-being was also significant (r = 0.072, 95% CI [0.026, 0.118], p < 0.01). The number of environmental factors involved in AFEs moderated the association with physical well-being, from which the association was only significant among studies focusing on fewer environmental factors (n < 6). Results of this meta-analysis indicated that AFEs may be more effective in promoting the emotions of older adults, compared to ameliorating their physical functioning. The limitations of current empirical studies and directions for future research in the field of environmental gerontology were also discussed.

Age-Friendly Communities and Older Adults' Health in the United States.

As age-friendly community (AFC) initiatives grow, it will be essential to determine whether older adults who live in an AFC have better health than those who live in other environments. This study uses data from the 2017 AARP AFC Surveys and the AARP Livability Index to assess whether AFCs promote the health of older adults. We analyze data for 3027 adults aged 65 and older who reside in 262 zip code areas. Following AARP guidelines, we allocated the sample into two groups: an AFC group (livability score of 51+; n = 2364) and a non-AFC (score ≤ 50, n = 663). The outcome variable was self-rated health (M = 3.5; SD = 1.1; range: 1-5). We used an inverse probability weighting approach to evaluate whether older adults who live in an AFC reported better self-rated health than those who live in a non-AFC. Findings showed that older adults who lived in an AFC had better self-rated health than those in a non-AFC (b = 0.08, p = 0.027). Compared to non-Hispanic Whites, Black and Hispanic older adults reported worse self-rated health. Inasmuch as living in an AFC can promote the well-being of older adults, policymakers and practitioners should continue to develop and sustain high-quality, accessible built and social environments.

Responding to Local Needs by Mobilizing Community Assets: Age-Friendly Community Initiatives During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: Age-friendly community initiatives (AFCIs) strive to make localities better for long and healthy lives by fostering improvements across social, physical, and service environments. Despite the heightened need for community supports during the coronavirus disease 2019 pandemic, very little research has addressed the work of AFCIs in the context of this crisis. We aimed to develop theory on how AFCI core teams have contributed to community responses during the pandemic, as well as what contexts have influenced the initiatives' ability to contribute. RESEARCH DESIGN AND METHODS: As part of a multiyear, community-partnered study on the development of philanthropically supported initiatives in northern New Jersey, we conducted qualitative interviews with 8 AFCI core teams during the winter of 2020-2021. The interviews focused on the leaders' efforts at that time, with probing questions concerning enabling factors for their community responses. We analyzed the data using an inductive coding process encompassing open, axial, and subcoding. RESULTS: The analysis indicated four distinct roles of AFC core groups: good community partner, creator, advocate, and communications broker. We further found that AFC leaders primarily drew on three types of capital-human, social, and tangible-to enact these roles, oftentimes in cumulative ways. DISCUSSION AND IMPLICATIONS: We interpret our study's findings and their implications by integrating insights from theories of social impact. We further highlight the importance of continued research on community-centered approaches to promote aging in community during times of societal crisis, and otherwise.

Age-Friendly Cities and Communities: Research to Strengthen Policy and Practice.

Since the early 2000s, a global age-friendly movement has emerged with aspirations to make environments and systems within localities more supportive of long and healthy lives. Despite growth in the social movement over the past decade, research on how to work toward community change, especially in systematic and comprehensive ways across diverse geo-political and sociocultural contexts, has been relatively slower to develop. This special issue of the Journal of Aging & Social Policy aims to accelerate this area. It features articles that advance knowledge on processes and contexts toward enhancing the age-friendliness of cities and communities. In this introductory essay, we provide background on the age-friendly cities and communities movement - including its accomplishments alongside key challenges. We then discuss the importance of research at the intersection of policy and practice to strengthen the movement into the 21st century. Next, we introduce the articles in this special issue, organized under four themes: implementation and sustainability processes; partnerships and multisectoral collaboration; theory-based program design; and policy and practice diffusion. A final article provides an overview of the career contributions of Dr. Frank Caro, an age-friendly champion and gerontologist to whom this special issue is dedicated.

Assessing Age-Friendly Community Progress: What Have We Learned?

BACKGROUND AND OBJECTIVES: The Global Network of Age-Friendly Cities and Communities has grown steadily over the past decade across the United States. The age-friendly model calls for a 5-year process of continuous improvement across the stages of engagement, planning, action, and measurement, culminating in an evaluation of age-friendly progress. However, surprisingly, little is known regarding American age-friendly communities' accomplishments to date. RESEARCH DESIGN AND METHODS: We utilized content analysis to assess the progress reported by American age-friendly communities (n = 30) that joined by end of year 2015 using the Age-Friendly Community Evidence-based Tool with expanded program evaluation measures including health equity as defined by the World Health Organization. We employed deductive analytic techniques to assess reported community performance in 11 thematic areas across the range of structures and processes that characterize age-friendly efforts. RESULTS: We found strong evidence in the areas of leadership and governance, harnessed resources, application of the age-friendly framework, and in multisector collaboration as well as reported provisions. All of the communities reported health equity aims, particularly in promoting accessible physical environments and social inclusion efforts. Our analysis further revealed relatively moderate evidence of older adult involvement and weak performance in the monitoring and reporting of evaluative findings as well as overall summation and dissemination plans. DISCUSSION AND IMPLICATIONS: We conclude by synthesizing the overall performance reported by the age-friendly communities, highlighting both strengths and weaknesses. We also offer suggestions to enhance evaluative efforts and advance the dissemination of age-friendly community progress.

Improvement in Quality of Life with Use of Ambient-Assisted Living: Clinical Trial with Older Persons in the Chilean Population.

In Chile, 18% of the population is over 60 years old and is projected to reach 31% in three decades. An aging population demands the development of strategies to improve quality of life (QoL). In this randomized trial, we present the implementation and evaluation of the Quida platform, which consists of a network of unintrusive sensors installed in the houses of elderly participants to monitor their activities and provide assistance. Sixty-nine elderly participants were included. A significant increase in overall QoL was observed amongst participants allocated to the interventional arm (p < 0.02). While some studies point out difficulties monitoring users at home, Quida demonstrates that it is possible to detect presence and movement to identify patterns of behavior in the sample studied, allowing us to visualize the behavior of older adults at different time intervals to support their medical evaluation.

Moving around a Large City in Latin America: The Mobility Challenges Faced by Older Adults with Disabilities.

A growing body of research has shown that barriers in the urban environment can be disabling by reducing the ability of older people to manage independently in the community, but also because they can negatively affect health by limiting the possibilities to move outside the home. In this study, we ask how obstacles in the urban environment are associated with the need for help to go to places in the community. To respond to this question, we used the Annual Household Survey of the City of Buenos Aires, Argentina 2018, which had a specific questionnaire for people with disabilities. From this sample, we selected adults aged 65 years or older with difficulties in at least one of six domains: vision; hearing; upper and lower body mobility; cognition; self-care; and communication. The final sample consisted of 513 persons (weighted = 109,316). First, we conducted a principal component analysis identifying three factors from variables of obstacles to access and use the urban environment: transportation; outdoor spaces; and information. Second, through a logistic regression model, we observed a direct relationship between these factors and the need for help to move in the community, controlling for sociodemographic characteristics, health status, and number of disabilities. This paper provides evidence on the significance of improving urban spaces to reduce dependent mobility. In Latin America, cities still face many challenges in becoming more age-friendly.

Age-friendly environments and depressive symptoms among Korean adults: The mediating effects of loneliness.

OBJECTIVES: In this study, we examined (1) group differences with regard to age-friendly environments (AFE), loneliness, and depressive symptoms among younger, middle-aged, and older Korean adults; (2) the relationship of AFE to loneliness and depressive symptoms; and (3) the mediating effect of loneliness on the relationship between AFE and depressive symptoms among three Korean adult groups. METHOD: We used a cross-sectional survey design featuring multistage quota sampling. Study participants were 1,017 Korean adults aged 18 years or older. Multi-group structural equation modeling was used for data analysis. RESULTS: Statistically significant age group differences were found in the mean values of loneliness and depressive symptoms, but no significant age group differences in the mean values of AFE were observed. Older adults showed a significant relationship between AFE and loneliness, while their younger counterparts demonstrated a significant relationship between AFE and depressive symptoms. The mediating effect of loneliness on the association between AFE and depressive symptoms was found only for the older age group. CONCLUSION: The results of the study contribute to the existing understanding of AFE and mental health among Korean adults, while providing service providers and policy makers with fundamental background information on alleviating depression.

Age-Friendly Environments in ASEAN Plus Three: Case Studies from Japan, Malaysia, Myanmar, Vietnam, and Thailand.

Promoting age-friendly environment is one of the appropriate approaches to support quality of life toward ageing populations. However, the information regarding age-friendly environments in the Association of Southeast Asian Nations (ASEAN) Plus Three countries is still limited. This study aimed to survey the perceived age-friendly environments among ASEAN Plus Three older populations. This study employed cross-sectional quantitative research using multistage cluster sampling to select a sample of older adults in the capital cities of Japan, Malaysia, Myanmar, Vietnam and Thailand. The final sample was composed of 2171 older adults aged 55 years and over, including 140 Japanese, 510 Thai, 537 Malaysian, 487 Myanmarese, and 497 Vietnamese older adults. Data collection was conducted using a quantitative questionnaire with 20 items of perceived age-friendly environments with the rating scale based on the World Health Organization (WHO) standard. The score from the 20 items were analyzed and examined high-risk groups of "bad perception level" age-friendly environments using ordinal logistic regression. The research indicated the five highest inadequacies of age-friendly environments including: (1) participating in an emergency-response training session or drill which addressed the needs of older residents; (2) enrolling in any form of education or training, either formal or non-formal in any subject; (3) having opportunities for paid employment; (4) involvement in decision making about important political, economic and social issues in the community; and (5) having personal care or assistance needs met in the older adult's home setting by government/private care services. Information regarding the inadequacy of age-friendliness by region was evidenced to guide policy makers in providing the right interventions towards older adults' needs.

Employing Participatory Citizen Science Methods to Promote Age-Friendly Environments Worldwide.

The trajectory of aging is profoundly impacted by the physical and social environmental contexts in which we live. While "top-down" policy activities can have potentially wide impacts on such contexts, they often take time, resources, and political will, and therefore can be less accessible to underserved communities. This article describes a "bottom-up", resident-engaged method to advance local environmental and policy change, called Our Voice, that can complement policy-level strategies for improving the health, function, and well-being of older adults. Using the World Health Organization's age-friendly cities global strategy, we describe the Our Voice citizen science program of research that has specifically targeted older adults as environmental change agents to improve their own health and well-being as well as that of their communities. Results from 14 Our Voice studies that have occurred across five continents demonstrate that older adults can learn to use mobile technology to systematically capture and collectively analyze their own data. They can then successfully build consensus around high-priority issues that can be realistically changed and work effectively with local stakeholders to enact meaningful environmental and policy changes that can help to promote healthy aging. The article ends with recommended next steps for growing the resident-engaged citizen science field to advance the health and welfare of all older adults.

Age-friendliness of living environments from the older person's viewpoint: development of the Age-Friendly Environment Assessment Tool.

BACKGROUND: according to the World Health Organisation, the role of the environment for older adults is to maintain and facilitate independence and promote quality of life. However, measures that examine the environment in terms of its potential impact on older people are either oriented towards specific aspects of the environment, specifically designed for community-level assessment rather than individually oriented, or are unwieldy for everyday use. OBJECTIVES: this article describes the development and validation of the Age-Friendly Environment Assessment Tool (AFEAT), assessing whether individual function and frailty impact on perceptions of environmental age-friendliness. The extent to which such perceptions may have moderate impacts of frailty on outcomes such as need for care support, quality of life and loneliness is examined. METHODS: a total of 132 participants aged 58-96 were recruited from retirement villages and local communities in the Midlands of the UK. Participants completed the AFEAT, and a series of measures designed to assess frailty and assessments of quality of life, loneliness and perceptions of functional limitations. RESULTS: internal reliability assessment indicated that the AFEAT possesses a Cronbach's Alpha score of 0.745. The AFEAT significantly predicted quality of life and loneliness, accounting for 17.1% and 5.8% of variance respectively, indicating high concurrent and predictive validity. Furthermore, the AFEAT moderated the predictive strength of frailty in predicting the amount of formal care an individual receives, but not quality of life or loneliness. DISCUSSION: the AFEAT is a valid and reliable tool, and analyses highlight the need for an individual-oriented Age-Friendly environment tool.

Smart Healthy Age-Friendly Environments - Policy Recommendations of the Thematic Network SHAFE.

The European Commission (DG SANTE) launched a call for proposals in November 2017 on strategic initiatives for a Joint Statement in 2018. Ten proposals were voted until December 7th in the European Union Health Policy Platform[1]; the proposal under the theme Smart Healthy Age-Friendly Environments (SHAFE)[2] was the most voted and was confirmed by the European Commission in March 2018. In this context, since March 2018, Cáritas Coimbra and AFEdemy Ltd are thus coordinating one of the three Thematic Networks for 2018, SHAFE, in close cooperation with main partners, such as the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), the European Innovation Partnership on Smart Cities and Communities (EIP-SCC), the Reference Sites Collaborative Network, the European Covenant on Demographic Change, Eurocities, the European Health Telematics Association (EHTEL), the European Connected Health Alliance (ECHAlliance), the European Construction, Built Environment and Energy Efficient Building Technology Platform (ECTP) and the European Centre for Social Welfare Policy and Research. SHAFE aims to facilitate the creation of healthy and friendly environments for all ages through the use of new technologies, towards the production of a comprehensive and participatory Joint Statement. This document was presented to the European Commission on 12 November 2018, with five main areas of recommendations to the EC, Member States and other local, regional and national organisations and is open for endorsement and implementation from this date onwards.

Health tourism: an opportunity for sustainable development.

In February 2017, the "Programma Mattone Internazionale Salute" (ProMis), that is the Italian Program for Internationalization of Regional Health Systems of the Ministry of Health (MoH), presented the first version of its Position Paper on Health Tourism, which embeds a first shared approach to the recommendations expressed by the European Committee of Regions (CoR) on "Age-Friendly" tourism. The CoR stresses the importance of local and regional authorities in the coordination of multi-sectoral policies such as healthcare, social assistance, transport, urban planning and rural development in relation to the promotion of mobility, security, accessibility of services, including health care and social services. "Age-friendly" tourism is an example of an innovative tourist offer that strives to meet the health needs of the entire "traveling" population, with an integrated and cross-sector approach that involves various organizations operating in sectors such as healthcare, accessibility and transport. The aim of the workshop was to explore the interest of the stakeholders to participate in a systemic action in the field of "health" tourism, and to identify priority implementation areas that offer opportunities to take advantage of validated, innovative experiences that strengthen the accessibility to health and social services in regional, national and international contexts. This effort provides the opportunity to take advantage of aligning the European Structural and Investment Funds (ESIF) to the development of tourism, coherently with the needs and resources of local and regional health authorities.

Activity-Friendly Built Environments in a Super-Aged Society, Japan: Current Challenges and toward a Research Agenda.

There is a growing recognition of the role of built environment attributes, such as streets, shops, greenways, parks, and public transportation stations, in supporting people's active behaviors. In particular, surrounding built environments may have an important role in supporting healthy active aging. Nevertheless, little is known about how built environments may influence active lifestyles in "super-aged societies". More robust evidence-based research is needed to identify how where people live influences their active behaviors, and how to build beneficial space in the context of super-aged societies. This evidence will also be informative for the broader international context, where having an aging society will be the inevitable future. This commentary sought to move this research agenda forward by identifying key research issues and challenges in examining the role of built environment attributes on active behaviors in Japan, which is experiencing the longest healthy life expectancy, but rapid "super-aging", with the highest proportion of old adults among its population in the world.