A Framework for Measuring Neighborhood Walkability for Older Adults-A Delphi Consensus Study.

While mobility in older age is of crucial importance for health and well-being, it is worth noting that currently, there is no German language framework for measuring walkability for older adults that also considers the functional status of a person. Therefore, we combined the results of an expert workshop, a literature review, and a Delphi consensus survey. Through this, we identified and rated indicators relevant for walkability for older adults, additionally focusing on their functional status. The expert workshop and the review led to an extensive list of potential indicators, which we hope will be useful in future research. Those indicators were then adapted and rated in a three-stage Delphi expert survey. A fourth additional Delphi round was conducted to assess the relevance of each indicator for the different frailty levels, namely "robust," "pre-frail," and "frail." Between 20 and 28 experts participated in each round of the Delphi survey. The Delphi process resulted in a list of 72 indicators deemed relevant for walkability in older age groups, grouped into three main categories: "Built environment and transport infrastructure," "Accessibility and meeting places," and "Attractiveness and sense of security." For 35 of those indicators, it was suggested that functional status should be additionally considered. This framework represents a significant step forward in comprehensively covering indicators for subjective and objective walkability in older age, while also incorporating aspects of functioning relevant to older adults. It would be beneficial to test and apply the indicator set in a community setting.

[The contribution of health conferences and health regions to regional planning and management in health care: an overview at the federal states level]. / Der Beitrag von Gesundheitskonferenzen und Gesundheitsregionen zu regionaler Planung und Steuerung im Gesundheitswesen ­ ein Überblick auf Ebene der Bundesländer.

Demands for increased health care coordination and cooperation have been raised for a long time in Germany. Over the past years, the public health services in the federal states have initiated networks at the regional level dealing with health-related topics, namely health conferences and health regions. In the areas of health promotion and prevention, health care services and nursing care sector, these networks make an important contribution to regional planning and management by setting up networks among relevant municipal players and developing a more comprehensive approach. This narrative review, worked out in collaboration with experts from the German federal states, aims to present an overview of the characteristics, key topics and results of health conferences and health regions. Furthermore, we describe differences and similarities between the approaches in the federal states as well as the respective supporting measures in the context of funding programmes and the legal basis. The results show that health conferences and health regions are established in a great number of administrative districts in the federal states. There have been many health conferences and health regions since years and, according to the evaluations, show positive impacts on regional cooperation across departmental, sectoral and professional boundaries. They deal with a wide range of topics related to local needs and problems aiming to use synergies and meet challenges in the regional provision of healthcare and prevention measures. Besides building network capacities, the assessment of local needs and the development of strategies, health conferences and health regions also initiate numerous local cooperation projects to improve the health of the population. Against the background of expected future challenges that will have to be faced by the public health services, we finally discuss the significance of regional planning and management functions of the public health services. We also we provide some recommendations related to the conditions for setting up health conferences and health regions and discuss their future development.

Walking and Walkability in Pre-Set and Self-Defined Neighborhoods: A Mental Mapping Study in Older Adults.

Neighborhood walkability contributes to older adults’ walking. However, associations vary depending on the neighborhood definition applied as well as between objective and perceived walkability measures. Therefore, this study aimed to comparatively assess walkability indices for commonly used pedestrian network buffers and perceived neighborhood areas. A total of 97 adults aged ≥65 years answered a written physical activity questionnaire and 69 respondents participated in face-to-face interviews that involved mental mapping, i.e., to draw perceived neighborhood delineations on paper maps. Hierarchical regression analyses were used to compare the contribution of walkability indices for pre-set buffers and self-defined neighborhoods to older adults’ walking after adjusting for covariates. Results show that older adults’ self-defined neighborhoods are significantly larger, less home-centered, and more walkable than commonly used buffers. Furthermore, the variance accounted for in neighborhood walking increased from 35.9% to 40.4% (ΔR² = 0.046; p = 0.029), when the walkability index was calculated for self-defined neighborhoods rather than pre-set buffers. Therefore, the study supports that geometric differences between pre-set buffers and older adults’ spatial ideas of perceived neighborhoods have a significant influence on estimated walkability effects and that exposure areas should be matched with the spatial dimension of outcome variables in future research.