Neighborhood Resources Associated With Active Travel in Older Adults-A Cohort Study in Six European Countries.

OBJECTIVES: To study associations between perceived neighborhood resources and time spent by older adults in active travel. METHODS: Respondents in six European countries, aged 65-85 years, reported on the perceived presence of neighborhood resources (parks, places to sit, public transportation, and facilities) with response options "a lot," "some," and "not at all." Daily active travel time (total minutes of transport-related walking and cycling) was self-reported at the baseline (n = 2,695) and 12-18 months later (n = 2,189). RESULTS: Reporting a lot of any of the separate resources (range B's = 0.19-0.29) and some or a lot for all four resources (B = 0.22, 95% confidence interval [0.09, 0.35]) was associated with longer active travel time than reporting none or fewer resources. Associations remained over the follow-up, but the changes in travel time were similar, regardless of the neighborhood resources. DISCUSSION: Perceiving multiple neighborhood resources may support older adults' active travel. Potential interventions, for example, the provision of new resources or increasing awareness of existing resources, require further study.

Minimal clinically important decline in physical function over one year: EPOSA study.

BACKGROUND: The Australian/Canadian hand Osteoarthritis Index (AUSCAN) and the Western Ontario and McMaster Universities knee and hip Osteoarthritis Index (WOMAC) are the most commonly used clinical tools to manage and monitor osteoarthritis (OA). Few studies have as yet reported longitudinal changes in the AUSCAN index regarding the hand. While there are published data regarding WOMAC assessments of the hip and the knee, the two sites have always evaluated separately. The current study therefore sought to determine the minimal clinically important difference (MCID) in decline in the AUSCAN hand and WOMAC hip/knee physical function scores over 1 year using anchor-based and distribution-based methods. METHODS: The study analysed data collected by the European Project on Osteoarthritis, a prospective observational study investigating six adult cohorts with and without OA by evaluating changes in the AUSCAN and WOMAC physical function scores at baseline and 12-18 months later. Pain and stiffness scores, the performance-based grip strength and walking speed and health-related quality of life measures were used as the study's anchors. Receiver operating characteristic curves and distribution-based methods were used to estimate the MCID in the AUSCAN and WOMAC physical function scores; only the data of those participants who possessed paired (baseline and follow up-measures) AUSCAN and WOMAC scores were included in the analysis. RESULTS: Out of the 1866 participants who were evaluated, 1842 had paired AUSCAN scores and 1845 had paired WOMAC scores. The changes in the AUSCAN physical function score correlated significantly with those in the AUSCAN pain score (r = 0.31). Anchor- and distribution-based approaches converged identifying 4 as the MCID for decline in the AUSCAN hand physical function. Changes in the WOMAC hip/knee physical function score were significantly correlated with changes in both the WOMAC pain score (r = 0.47) and the WOMAC stiffness score (r = 0.35). The different approaches converged identifying two as the MCID for decline in the WOMAC hip/knee physical function. CONCLUSIONS: The most reliable MCID estimates of decline over 1 year in the AUSCAN hand and WOMAC hip/knee physical function scores were 4 and 2 points, respectively.

Within-person pain variability and physical activity in older adults with osteoarthritis from six European countries.

BACKGROUND: This study examines the association of both pain severity and within-person pain variability with physical activity (PA) in older adults with osteoarthritis (OA). METHODS: Data from the European Project on OSteoArthritis were used. At baseline, clinical classification criteria of the American College of Rheumatology were used to diagnose OA in older adults (65-85 years). At baseline and 12-18 months follow-up, frequency and duration of participation in the activities walking, cycling, gardening, light and heavy household tasks, and sports activities were assessed with the Longitudinal Aging Study Amsterdam Physical Activity Questionnaire. Physical activity was calculated in kcal/day, based on frequency, duration, body weight and the metabolic equivalent of each activity performed. At baseline and 12-18 months follow-up, pain severity was assessed using the pain subscales of the Western Ontario and McMaster Universities OA Index and the Australian/Canadian Hand OA Index. Within-person pain variability was assessed using two-week pain calendars that were completed at baseline, 6 months follow-up and 12-18 months follow-up. RESULTS: Of all 669 participants, 70.0% were women. Sex-stratified multiple linear regression analyses showed that greater pain severity at baseline was cross-sectionally associated with less PA in women (Ratio = 0.95, 95% CI = 0.90-0.99), but not in men (Ratio = 0.99, 95% CI = 0.85-1.15). The longitudinal analyses showed a statistically significant inverse association between pain severity at baseline and PA at follow-up in women (Ratio = 0.94, 95% CI = 0.89-0.99), but not in men (Ratio = 1.00, 95% CI = 0.87-1.11). Greater pain variability over 12-18 months was associated with more PA at follow-up in men (Ratio = 1.18, 95% CI = 1.01-1.38), but not in women (Ratio = 0.94, 95% CI = 0.86-1.03). CONCLUSIONS: Greater pain severity and less pain variability are associated with less PA in older adults with OA. These associations are different for men and women. The observed sex differences in the various associations should be studied in more detail and need replication in future research.

Concordance between clinical and radiographic evaluations of knee osteoarthritis.

BACKGROUND: Significant correlation has been previously demonstrated between radiographic and clinical diagnoses of knee osteoarthritis (OA); however, the specific findings on clinical examination that relate best to a radiographic diagnosis have not been fully elicited. AIMS: We aimed to explore the relationship between clinical symptoms and physical findings with radiographic diagnoses of tibiofemoral and patellofemoral OA. METHODS: This study was based on 409 individuals from the Hertfordshire Cohort Study, born between 1931 and 1939. Antero-posterior and lateral radiographs were taken of both knees. The presence of tibiofemoral and patellofemoral OA was defined according to the Kellgren and Lawrence score. Clinical symptoms, assessed using WOMAC, and physical findings were ascertained by examination. Relationships were assessed using multilevel univariate logistic regression. RESULTS: In the 775 knees studied, the prevalence of physical findings was crepitus (25%), tibiofemoral tenderness (15%), bony swelling (12%), and pain on flexion (10%). Thirty-one percent (n = 238) knees demonstrated tibiofemoral OA, 28% (n = 220) showed patellofemoral OA, and 16% demonstrated OA in both locations. A global clinical symptom score was associated with increased risk of tibiofemoral OA (OR 12.5, 95% CI 5.4-29.0) and patellofemoral OA (OR 5.1, 95% CI 2.3-13.1). On clinical examination, the presence of crepitus, tibiofemoral tenderness, bony swelling, and pain on flexion was associated with increased risk of tibiofemoral OA; however, only tenderness was found to be associated with patellofemoral OA. CONCLUSION: Global clinical symptom score was associated with radiographic tibiofemoral and patellofemoral OA. However, individual clinical signs were more strongly associated with tibiofemoral than patellofemoral OA.

A life course perspective on working beyond retirement-results from a longitudinal study in the Netherlands.

BACKGROUND: There is a societal need that workers prolong their working lives. By adopting a life course perspective, this study aimed to investigate the influence of work motives and motivation, health, job characteristics, skills, and financial and social situation on working beyond retirement, and differences between 'on time' and 'off time' retirees (retirement age 65 and <65 years, respectively). METHODS: Retirees aged 57 to 67 years (N = 1,054) who participated in the Dutch Study on Transitions in Employment, Ability and Motivation were included in this study. Participants filled out a questionnaire in 2010, 2011, 2012, and 2013. Predictors of working beyond retirement were identified using logistic regression analyses, and stratified analyses were performed to investigate differences between 'off time' and 'on time' retirees. RESULTS: High work engagement (OR = 1.3), good physical health (OR = 1.8), poor financial situation (OR = 2.4), and voluntary work (OR = 1.5) predicted working beyond retirement. For 'off time' retirees, no financial possibility to retire early (OR = 1.8) and not having a partner (OR = 1.9) predicted working beyond retirement. 'On time' retirees reporting more support at work (OR = 0.7) and without the financial possibility to retire early (OR = 0.5), worked beyond retirement less often. CONCLUSIONS: The results indicated that especially the motivation to work, physical health and the financial situation were the most relevant aspects with regard to working beyond retirement, which supports the idea that the principle of 'human agency' of the life course perspective is useful to understand factors that impact working beyond retirement. Most aspects of the life course principles of 'linked lives' and 'timing' seemed to be less relevant.

The association of the neighbourhood built environment with objectively measured physical activity in older adults with and without lower limb osteoarthritis.

BACKGROUND: This study examined the associations of objectively measured neighbourhood built environment characteristics with objectively measured physical activity (PA) in older people with and without lower limb osteoarthritis (LLOA), and assessed whether these relationships differ between both groups. METHODS: Data from the Dutch component of the European Project on OSteoArthritis were used. American College of Rheumatology classification criteria were used to diagnose LLOA (knee and/or hip osteoarthritis). Daily average time spent on total PA and separate PA intensity categories, including light PA, low-light PA, high-light PA, and moderate to vigorous PA, were measured using Actigraph GT3X accelerometers. Geographic Information Systems were used to measure street connectivity (number of street connections per km(2)) and distances (in km) to resources (health care resources, retail resources, meeting places, and public transport) within neighbourhoods. Multiple Linear Regression Analyses were used to examine the associations between measures of the neighbourhood built environment and PA, adjusted for several confounders. RESULTS: Of all 247 participants (66-85 years), 41 (16.6 %) had LLOA. The time spent on any PA did not differ significantly between participants with and without LLOA (LLOA: Mean = 268.3, SD = 83.3 versus non-LLOA: Mean = 275.8, SD = 81.2; p = 0.59). In the full sample, no measures of the neighbourhood built environment were statistically significantly associated with total PA. Larger distances to specific health care resources (general practice and physiotherapist) and retail resources (supermarket) were associated with more time spent on PA in older people with LLOA than in those without LLOA. In particular, the associations of light and high-light PA with distances to these specific resources were stronger in participants with LLOA compared to their counterparts without LLOA. CONCLUSIONS: Specific attributes of the neighbourhood built environment are more strongly associated with PA in older people with LLOA than in those without LLOA. Knowledge on the relationship between objectively measured neighbourhood characteristics and PA in older people with and without LLOA could be used to inform policymakers and city planners about adaptation of neighbourhoods and their infrastructures to appropriately facilitate PA in healthy and functionally impaired older adults.

Osteoarthritis and frailty in elderly individuals across six European countries: results from the European Project on OSteoArthritis (EPOSA).

BACKGROUND: Osteoarthritis (OA) is the most common cause of disability in the elderly. Clinical frailty is associated with high mortality, but few studies have explored the relationship between OA and frailty. The objective of this study was to consider the association between OA and frailty/pre-frailty in an elderly population comprised of six European cohorts participating in the EPOSA project. METHODS: Longitudinal study using baseline data and first follow-up waves, from EPOSA; 2,455 individuals aged 65-85 years were recruited from pre-existing population-based cohorts in Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. Data were collected on clinical OA at any site (hand, knee or hip), based on the clinical classification criteria developed by the American College of Rheumatology (ACR). Frailty was defined according to Fried's criteria. The covariates considered were age, gender, educational level, obesity and country. We used multinomial logistic regression to analyse the associations between OA, frailty/pre-frailty and other covariates. RESULTS: The overall prevalence of clinical OA at any site was 30.4 % (95 % CI:28.6-32.2); frailty was present in 10.2 % (95 % CI:9.0-11.4) and pre-frailty in 51.0 % (95 % CI:49.0-53.0). The odds of frailty was 2.96 (95 % CI:2.11-4.16) and pre-frailty 1.54 (95 % CI:1.24-1.91) as high among OA individuals than those without OA. The association remained when Knee OA, hip OA or hand OA were considered separately, and was stronger in those with increasing number of joints. CONCLUSIONS: Clinical OA is associated with frailty and pre-frailty in older adults in European countries. This association might be considered when designing appropriate intervention strategies for OA management.

Loneliness of Older Immigrant Groups in Canada: Effects of Ethnic-Cultural Background.

This study aimed to explore the loneliness of several groups of older immigrants in Canada compared to native-born older adults. Data from the Canadian General Social Survey, Cycle 22 (N older adults = 3,692) were used. The dependent variable is the 6 item De Jong Gierveld loneliness scale. Determinants of loneliness included country of birth, ethnic background (cultural context); belongingness (community context) and social networks (social context). Results showed that only some immigrant groups are significantly lonelier than older adults born in Canada. Immigrants with similar language and culture are not lonelier; while those from countries that differ in native language/culture are significantly higher on loneliness. Multivariate analyses showed the importance of cultural background, of composition of the network of relatives and friends, and of local participation and feelings of belonging to the Canadian society in explaining loneliness of older immigrants.

Relationships between physical performance and knee and hip osteoarthritis: findings from the European Project on Osteoarthritis (EPOSA).

BACKGROUND: poor physical performance (PP) is known to be associated with disability, lower quality of life and higher mortality rates. Knee and hip osteoarthritis (OA) might be expected to contribute to poor PP, through joint pain and restricted range of movement. Both clinical and self-reported OA are often used for large-scale community and epidemiological studies. OBJECTIVE: to examine the relationships between hip and knee OA and PP in a large data set comprising cohorts from six European countries. METHODS: a total of 2,942 men and women aged 65-85 years from the Germany, Italy, Netherlands, Spain, Sweden and the UK were recruited. Assessment included an interview and clinical assessment for OA. PP was determined from walking speed, chair rises and balance (range 0-12); low PP was defined as a score of ≤9. RESULTS: the mean (SD) age was 74.2 (5.1) years. Rates of self-reported OA were much higher than clinical OA. Advanced age, female gender, lower educational attainment, abstinence from alcohol and higher body mass index were independently associated with low PP. Clinical knee OA, hip OA or both were associated with a higher risk of low PP; OR (95% CI) 2.93 (2.36, 3.64), 3.79 (2.49, 5.76) and 7.22 (3.63, 14.38), respectively, with relationships robust to adjustment for the confounders above as well as pain. CONCLUSION: lower limb OA at the hip and knee is associated with low PP, and for clinical diagnosis relationships are robust to adjustment for pain. Those at highest risk have clinical OA at both sites.

Development and validation of a physical and psychosocial job-exposure matrix in older and retired workers.

OBJECTIVES: A general population job-exposure matrix (GPJEM) including physical and psychosocial demands as well as psychosocial resources applicable to older and retired workers was developed. Its validity was evaluated by examining associations of physical demands and iso-strain (combination of high psychosocial demands and low resources) with health. METHODS: Physical and psychosocial work exposures reported by 55-64 year olds were derived from the Netherlands Working Conditions Survey and linked to the Netherlands Standard Classification of Occupations 1992. A GPJEM with low, moderate, and high probability of exposure to demands and resources was developed. To examine associations with health, two groups of the Longitudinal Aging Study Amsterdam were selected: current (i.e. at the time of the interview, 55-64 years) and former workers (55-84 years). Linear and logistic regression models were applied. RESULTS: Use of force and work in uncomfortable positions were significantly associated with functional limitations and self-perceived health (SPH), but not hip or knee osteoarthritis (OA), in current and former workers. A moderate probability of repetitive movements was associated with functional limitations in former workers. A high probability of repetitive movements was associated with functional limitations in current and former workers as well as with SPH and hip and knee OA in former workers. Respondents formerly exposed to iso-strain had significantly higher diastolic blood pressure and more often hypertension. No such associations were found in current workers. No association was found with cardiovascular disease. CONCLUSIONS: The results suggest that our GPJEM accurately classifies jobs according to physical demands and, although less clearly, iso-strain.

Self-perceived weather sensitivity and joint pain in older people with osteoarthritis in six European countries: results from the European Project on OSteoArthritis (EPOSA).

BACKGROUND: People with osteoarthritis (OA) frequently report that their joint pain is influenced by weather conditions. This study aimed to examine whether there are differences in perceived joint pain between older people with OA who reported to be weather-sensitive versus those who did not in six European countries with different climates and to identify characteristics of older persons with OA that are most predictive of perceived weather sensitivity. METHODS: Baseline data from the European Project on OSteoArthritis (EPOSA) were used. ACR classification criteria were used to determine OA. Participants with OA were asked about their perception of weather as influencing their pain. Using a two-week follow-up pain calendar, average self-reported joint pain was assessed (range: 0 (no pain)-10 (greatest pain intensity)). Linear regression analyses, logistic regression analyses and an independent t-test were used. Analyses were adjusted for several confounders. RESULTS: The majority of participants with OA (67.2%) perceived the weather as affecting their pain. Weather-sensitive participants reported more pain than non-weather-sensitive participants (M = 4.1, SD = 2.4 versus M = 3.1, SD = 2.4; p < 0.001). After adjusting for several confounding factors, the association between self-perceived weather sensitivity and joint pain remained present (B = 0.37, p = 0.03). Logistic regression analyses revealed that women and more anxious people were more likely to report weather sensitivity. Older people with OA from Southern Europe were more likely to indicate themselves as weather-sensitive persons than those from Northern Europe. CONCLUSIONS: Weather (in)stability may have a greater impact on joint structures and pain perception in people from Southern Europe. The results emphasize the importance of considering weather sensitivity in daily life of older people with OA and may help to identify weather-sensitive older people with OA.

Predictors of having paid work in older workers with and without chronic disease: a 3-year prospective cohort study.

BACKGROUND: As the prevalence of chronic disease amongst older workers is high and increasing, it is important to know if the large subgroup of older workers with chronic disease has specific needs when it comes to prolonging participation in paid work. OBJECTIVES: To investigate differences and similarities in predictors of having paid work in workers aged 55+ with and without chronic disease. METHODS: Workers aged 55-62 years were selected from the 2002-2003 cohort of the Longitudinal Aging Study Amsterdam (n = 333). Potential predictors were: health, personality, work characteristics, and demographics. Per potential predictor, a logistic regression coefficient for 'having paid work in 2005-2006' was calculated for workers with and without chronic disease. A pooled estimate was computed and differences between the pooled estimate and the coefficients were tested. Results Follow-up data were available for 95 %, of whom 67 % still had paid work. Predictors of having paid work were similar for workers with and without chronic diseases, except for physical workload (χ(2) = 5.37; DF = 1) and psychosocial resources at work (χ(2) = 5.94; DF = 1). Having more psychosocial resources (OR = 3.57; 95 %CI 1.33-10.0) was predictive for having paid work in workers with chronic disease and not in workers without chronic disease. Lower age, more weekly working hours, no functional limitations, fewer depressive symptoms, lower neuroticism scores, and more sense of mastery were significantly associated with having paid work in all workers. CONCLUSIONS: Differences between predictors of having paid work between workers with and without chronic disease should be taken into account when aiming to prevent exit from the workforce. In particular the vulnerable subgroup of older workers with chronic disease and low psychosocial resources at work is more likely to quit working.

European project on osteoarthritis: design of a six-cohort study on the personal and societal burden of osteoarthritis in an older European population.

BACKGROUND: Osteoarthritis (OA), the most common form of arthritis, is a major contributor to functional impairment and loss of independence in older persons. The European Project on OSteoArthritis (EPOSA) is a collaborative study involving six European cohort studies on ageing. This project focuses on the personal and societal burden and its determinants of osteoarthritis. This paper describes the design of the project, and presents some descriptive analyses on selected variables across countries. METHODS/DESIGN: EPOSA is an observational study including pre-harmonized data from European cohort studies (Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom) on older community-dwelling persons aged 65 to 85 years. In total, 2942 persons were included in the baseline study with a mean age of 74.2 years (SD 5.1), just over half were women (51,9%). The baseline assessment was conducted by a face-to-face interview followed by a clinical examination. Measures included physical, cognitive, psychological and social functioning, lifestyle behaviour, physical environment, wellbeing and care utilisation. The clinical examination included anthropometry, muscle strength, physical performance and OA exam. A follow-up assessment was performed 12-18 months after baseline. DISCUSSION: The EPOSA study is the first population-based study including a clinical examination of OA, using pre-harmonized data across European countries. The EPOSA study provides a unique opportunity to study the determinants and consequences of OA in general populations of older persons, including both care-seeking and non care-seeking persons.

Health trajectories across the work exit transition in the 1990s, 2000s, and 2010s: the role of working conditions and policy.

PURPOSE: We examined health trajectories of Dutch older workers across their exit from the workforce in the 1990s, 2000s, and 2010s, testing the hypothesis that pre-post-exit health trajectories of workers with favourable and unfavourable working conditions increasingly diverged over time due to policy measures to extend working life. METHODS: The Longitudinal Aging Study Amsterdam includes baseline samples in 1992/1993, 2002/2003 and 2012/2013 with two 3-year follow-up waves each. Selected respondents were aged 55 years and over who exited from a paid job within the first or second 3-year interval, up to and including the statutory retirement age (N = 522). Pre-post-exit trajectories were modelled using Generalized Estimating Equations with outcomes self-rated health and physical limitations and determinants physical demands, psychosocial demands, and psychosocial resources. RESULTS: Average work exit age rose from 60.7 in the 1990s to 62.9 in the 2010s. On average, self-rated health decreased somewhat over successive periods and did not show pre-post-exit change; average physical limitations increased substantially both over successive periods and from pre- to post-exit. No support is found for our hypothesis. However, regardless of work exposures, we found sharp pre-post-exit increases in physical limitations in the 2010s. CONCLUSION: Although these findings provide no support for our hypothesis of diverging health trajectories over time based on work exposure, they show that exiting at a higher age is linked to poorer pre- and post-exit health and to pre-post-exit increases in physical limitations, suggesting greater health care costs in the near future.

Collaboration to combat COVID-19: policy responses and best practices in local integrated care settings.

PURPOSE: This illustrative case study describes and evaluates drivers of effective inter-organizational collaboration to mitigate the impact and spread of COVID-19 among homeless people in two cities in the Netherlands. The aims of this study are: (1) to explore the strategic and operational policy responses in two local integrated care settings at the start of the crisis, (2) to identify best policy practices and lessons learned. The authors interpret and evaluate the findings by combining insights from the population health management (PHM) and collaborative governance literature. DESIGN/METHODOLOGY/APPROACH: The authors describe and illustrate the experiences of two Dutch municipalities, Rotterdam and The Hague, in the early policy responses to sudden operational challenges around the impact of COVID-19 on homeless people as experienced by local decision-makers, medical doctors and clients. FINDINGS: The authors show that best policy practices revolve around (1) using data and risk stratification methods for identifying and targeting populations at-risk in local policy making, and (2) having an inter-organizational data sharing architecture in place ex ante. These two factors were clear prerequisites for tailor-made policy responses for newly-defined groups at risk with the existing and well-documented vulnerable population, and executing crisis-induced tasks efficiently. ORIGINALITY/VALUE: This paper is among the first to illustrate the potential of combining collaborative governance and PHM perspectives to identify key drivers of effective local governance responses to a healthcare crisis in an integrated care setting.

[Patient involvement during crises]. / Patiëntbetrokkenheid tijdens crisisbesluitvorming: Lessen voor de toekomst op basis van COVID-19.

Patient involvement is an important topic in health care. Client councils are one way through which patients are involved in decision-making. However, we know little about their role during crises, and what we can learn from these experiences. We argue that there was little patient involvement in the top-down and centralized decision-making during the COVID-19 crisis. Furthermore, many decisions were taken in interorganizational networks, where patient involvement is rare. Based on these findings, we argue that health care organizations and client councils should rethink what effective patient involvement looks like during crises and in interorganizational networks.

Exploring Health Trends Prior to State Pension Age for The Netherlands up to 2040.

BACKGROUND: In many Western countries, the state pension age is being raised to stimulate the extension of working lives. It is not yet well understood whether the health of older adults supports this increase. In this study, future health of Dutch adults aged 60 to 68 (i.e., the expected state pension age) is explored up to 2040. METHODS: Data are from the Dutch Health Interview Survey 1990-2017 (N ≈ 10,000 yearly) and the Dutch Public Health Monitor 2016 (N = 205,151). Health is operationalized using combined scores of self-reported health and limitations in mobility, hearing or seeing. Categories are: good, moderate and poor health. Based on historical health trends, two scenarios are explored: a stable health trend (neither improving nor declining) and an improving health trend. RESULTS: In 2040, the health distribution among men aged 60-68 is estimated to be 63-71% in good, 17-28% in moderate and 9-12% in poor health. Among women, this is estimated to be 64-69%, 17-24% and 12-14%, respectively. CONCLUSIONS: This study's explorations suggest that a substantial share of people will be in moderate or poor health and, thus, may have difficulty continuing working. Policy aiming at sustainable employability will, therefore, remain important, even in the case of the most favorable scenario.

Towards a Better Understanding of the Sense of Safety and Security of Community-Dwelling Older Adults. The Case of the Age-Friendly City of The Hague.

The sense of safety and security of older people is a widely acknowledged action domain for policy and practice in age-friendly cities. Despite an extensive body of knowledge on the matter, the theory is fragmented, and a classification is lacking. Therefore, this study investigated how older people experience the sense of safety and security in an age-friendly city. A total of four focus group sessions were organised in The Hague comprising 38 older people. Based on the outcomes of the sessions, the sense of safety and security was classified into two main domains: a sense of safety and security impacted by intentional acts and negligence (for instance, burglary and violence), and a sense of safety and security impacted by non-intentional acts (for instance, incidents, making mistakes online). Both domains manifest into three separate contexts, namely the home environment, the outdoor environment and traffic and the digital environment. In the discussions with older people on these derived domains, ideas for potential improvements and priorities were also explored, which included access to information on what older people can do themselves to improve their sense of safety and security, the enforcement of rules, and continuous efforts to develop digital skills to improve safety online.

The Participation of Older People in the Concept and Design Phases of Housing in The Netherlands: A Theoretical Overview.

In the Netherlands, there is a growing need for collective housing for older people to bridge the gap between ageing-in-place and institutional care facilities. Participation of older people in the concept and design phases is important to tune the market supply to the needs of (future) residents, yet social entrepreneurs find it challenging to involve older people. This commentary explores various ways older people can participate in the development of new housing initiatives. The ladder of citizen participation is applied to explore different roles that (future) residents could play with levels of influence varying from non-participation to citizen power. Considerations for meaningful participation are discussed, in order to show how collaborations can be formed between (future) residents and decision makers.

Neighborhood environment, social participation, and physical activity in older adults with lower limb osteoarthritis: A mediation analysis.

Older adults with lower limb osteoarthritis (LLOA) are highly dependent on their physical and social environment for being physically active. Longitudinal data from 2286 older adults (Mage = 73.8 years; 50.3% female) in six European countries were analyzed using cross-lagged Structural Equation Modeling (SEM) and multi-group SEM. In cross-sectional analyses, neighborhood resources were associated with physical activity (r = 0.26;p < .001) and social participation (r = 0.13;p = .003). Physical activity at follow-up was associated with neighborhood resources, with this relationship mediated by social participation in people with LLOA (ß = 0.018;p = .013). To promote future physical activity, opportunities to socially engage in neighborhoods need to be targeted primarily to people with LLOA.