Equitable Healthy Aging in Community Health Improvement Practice.

The Equitable Healthy Aging in Public Health Toolkit provides local health departments with guidance on advancing equitable healthy aging in community health improvement practice. The toolkit includes modules on foundational principles such as social justice, social determinants of health and intersectionality across the life course, age-friendly public health frameworks, and evidence-based actions to advance equitable healthy aging in community health improvement infrastructure, assessment, implementation planning, and practice. The toolkit is based on contemporaneous public health knowledge and practice on healthy aging and health equity along with advisory input from the Trust for America's Health and the National Association of City and County Health Officials. The toolkit was informed by Florida Department of Health practitioners (n = 79) and further vetted and well received with a statewide master class of public health leaders (n = 29). The toolkit is publicly available and free of charge.

Creating age-friendly nursing homes: The time is now.

The current global age-friendly movement supports older adults by promoting different policies and services. However, there is a dearth of attention to nursing home (NH) residents as part of age-friendly movements. The pioneering idea of an age-friendly health system, i.e., the "4 Ms" model is significant for NHs and formative for further developments; however, it does not identify unique components of NH care. This article aims to identify specific aspects of person-centered care in the literature to advance the development of a standardized conceptual framework. Along with residents, NH staff and administrators are integral parts of NHs. Incorporating the central role of caregivers, this study proposes a new "8 Ms" framework to describe the age-friendly NH. The traditional 4 Ms model notes that everything related to care matters to residents, along with care related to medication, mobility, and mentation. The proposed age-friendly framework introduces five additional "M," i.e., meaningful care, motivation, moderation, modification, and monitoring. This framework is proposed to advance education, training, clinical practice, research, and advocacy to promote quality of care in NHs. Application of the 8 Ms framework may yield multiple benefits, assuring good quality of care to residents, caregivers' job satisfaction, and supporting NH management in providing residents optimal care.

Advancing Gerontological Nursing at the Intersection of Age-Friendly Communities, Health Systems, and Public Health.

Mounting efforts to improve care and promote healthy aging throughout society and across the care continuum have created unique opportunities for gerontological nursing practice. Population aging has invoked a multitude of responses among all levels of international and national organizations, foundations, health care, and government to meet the needs and promote preferences of older adults. Large-scale programs by the World Health Organization, The John A. Hartford Foundation, Institute for Health-care Improvement, and Trust for America's Health have galvanized to advance the momentum of age-friendly communities, health care, and public health. Gerontological nurses can leverage this growing interest in aging by enhancing their knowledge about age-friendly movements, influencing these movements with their expertise in evidence-based practices, and advancing their own competencies in caring for older adults in any setting. [Journal of Gerontological Nursing, 47(3), 13-17.].

Scripted drives: A robust protocol for generating exposures to traffic-related air pollution.

Commuting in automobiles can contribute substantially to total traffic-related air pollution (TRAP) exposure, yet measuring commuting exposures for studies of health outcomes remains challenging. To estimate real-world TRAP exposures, we developed and evaluated the robustness of a scripted drive protocol on the NJ Turnpike and local roads between April 2007 and October 2014. Study participants were driven in a car with closed windows and open vents during morning rush hours on 190 days. Real-time measurements of PM2.5, PNC, CO, and BC, and integrated samples of NO2, were made in the car cabin. Exposure measures included in-vehicle concentrations on the NJ Turnpike and local roads and the differences and ratios of these concentrations. Median in-cabin concentrations were 11 µg/m3 PM2.5, 40 000 particles/cm3, 0.3 ppm CO, 4 µg/m3 BC, and 20.6 ppb NO2. In-cabin concentrations on the NJ Turnpike were higher than in-cabin concentrations on local roads by a factor of 1.4 for PM2.5, 3.5 for PNC, 1.0 for CO, and 4 for BC. Median concentrations of NO2 for full rides were 2.4 times higher than ambient concentrations. Results were generally robust relative to season, traffic congestion, ventilation setting, and study year, except for PNC and PM2.5, which had secular and seasonal trends. Ratios of concentrations were more stable than differences or absolute concentrations. Scripted drives can be used for generating reasonably consistent in-cabin increments of exposure to traffic-related air pollution.

Dying in the age of choice.

Due to the unprecedented increase in the United States aging demographics, many more people are living longer and reaching older ages than ever before. However, a longer life is not necessarily a better life, as the vast majority will face a period of prolonged deteriorating health prior to death. Although notable efforts have been underway that are designed to improve the end-of-life experience, increasing numbers of individuals express a desire and/or act upon an intent to end their lives precipitously. Though still limited, the options to actively participate in their own deaths are growing. Requests for a hastened death can occur among people of all ages and includes those with advanced illness as well as others wanting to die due to unbearable suffering. This article provides an overview of the ongoing discourse about the experience of dying faced by many older adults, including aspects frequently associated with "a good death." The limitations of established practices which seek to provide a "better" dying experience are identified followed by discussion of the growing availability of alternative options. Reflective considerations are presented to guide practice vis-à-vis the changing landscape surrounding options in dying.

Brief report #1: engaging students in gerontological practice and research.

Caregivers Accessing Resources and Essential Services (CARES) is an innovative caregiver program that utilizes the "wraparound system of care" as its main intervention. The program is based on 10 core principles and conducted over a four-phase process. Undergraduate and graduate students gathered insight into the program's unique practice model by way of internships and shadowing the program's facilitators. Students are exposed to the unique needs of older caregivers who are disproportionately represented in the geographical area in which the program is located. In addition, students applied research concepts such as psychometric measures and treatment fidelity in evaluating the program. The program enhanced practice and research competencies along with knowledge of and sensitivity to older adult caregivers.

Engaging students in gerontological work through innovative caregiving programming: introduction to three brief reports.

The number of Americans aged 65 and older is projected to increase from 35 million to 88.5 million in the first half of the 21st century. However, there is a serious gap between the number of health care and social service practitioners needed to work with the aging and the number available and trained to do so. The authors review current research on what works in engaging students in geriatric and gerontological work. The authors then present three projects from the Weinberg Caregiver Initiative as illustrations of innovative caregiver programming building on community-based partnerships which successfully incorporate aspects of best practices in gerontological education to increase student interest in work with the aging populations, while serving older adults and their caregivers.

Establishing empirically-informed practice with caregivers: findings from the CARES program.

There is increasing interest in delivering efficacious interventions to caregivers. This study reports on the processes and findings from a modified approach of the Wraparound System of Care. The practice model is implemented over 4 phases and is based on 3 theoretical constructs and 10 principles. The evaluation utilized treatment fidelity measures and employed a quasi-experimental pretest/posttest design to examine caregiver outcomes (N = 120). Findings suggest significant improvement among caregivers' self-reported health, life satisfaction, well-being, and quality of life, as well as a reduction in caregiver risk and burden. Delineation of the processes used in the model are presented.

Exploring Sectoral Reach in Age-Friendly Communities.

BACKGROUND AND OBJECTIVES: There is growing interest in better understanding the sectoral reach of age-friendly community practice. Action across a wide range of actors is central to achieving age-friendly societal change, according to the World Health Organization and required for governmental participation in its Global Network of Age-Friendly Cities and Communities. However, there is limited knowledge regarding the scope of sectoral reach by age-friendly communities. RESEARCH DESIGN AND METHODS: We used qualitative inquiry to assess sectoral efforts reported by American age-friendly communities that completed a 5-year cycle of participation (n = 40). We employed directed content analysis using a priori indicators by sectoral actors: public (i.e., government), private (i.e., business), and civil society, including nonprofit organizations and volunteers. We classify sectoral actions by type (i.e., intersectoral and multisectoral) and by clustered domain community foci (i.e., built, social, and service). RESULTS: Our study identifies the extent and types of sectoral actors and actions reported by age-friendly communities with the greatest efforts reported in the public sector, and while similarly distributed across all the domains, slightly more efforts were noted in the built environment. We also found greater intersectoral efforts (i.e., explicitly working toward shared goals) than multisectoral (i.e., not necessarily in collaboration on shared goals), particularly across government. DISCUSSION AND IMPLICATIONS: While our study substantiates the breadth of actions toward age-friendly change, additional research is needed to examine the ways in which the public and other sectoral actions are further linked to outcomes in communities in the United States and in other countries.

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.

Theories of Community Collaboration to Advance Age-Friendly Community Change.

The age-friendly communities movement has grown rapidly in global prominence over the past 2 decades. However, theories to guide multisectoral action toward age-friendly community change have been slower to develop. We demonstrate the value of drawing on theories of community collaboration to inform age-friendly community efforts across engagement, planning, implementation, and measurement. We introduce 3 theories-Asset-Based Community Development, Strategic Doing, and Collective Impact-each with principles and strategies for guiding multisectoral group processes toward long-term and systematic community change. While distinct from each other, these theories collectively suggest the importance of incorporating a more explicit community-building approach within the age-friendly communities movement. We describe the implications of this integrative theory development for bolstering sustainable and comprehensive practices and policies to improve environments for aging across diverse communities.

Promoting advance care planning through the National Healthcare Decisions Day initiative.

National Healthcare Decisions Day is a nationwide campaign aimed at increasing advance care planning among adults throughout the country. This broad-scale initiative simultaneously seeks to encourage Americans to express their wishes regarding future healthcare decision making, rally a national media campaign to promote the importance of planning in advance for care, and mobilize national, state, and community organizations to develop a wide range of educational activities. The movement culminates in an annual day of multiple events throughout the country designed to inundate the public about advance care planning. The national event originated from the successful statewide Virginia Advance Directives Day's inaugural event, conducted on April 18, 2006. Social workers are encouraged to participate in this growing initiative through a variety of activities and roles. A description of a successful event conducted in a suburban Southeastern community is provided to illustrate the activities and roles performed by social work.

Examining Older Adults' Perspectives on the Built Environment and Correlates of Healthy Aging in an American Age-Friendly Community.

Population aging has led to an increased focus on the environmental context in which we age. While researchers have identified significant health benefits associated with built community features such as housing, transportation and outdoor spaces and buildings, less attention has focused on the correlates of healthy aging and other characteristics via the perspective of community-dwelling older adults. This study utilized cluster analysis to examine health-related subgroups of older adults (n = 598) in an age-friendly community located in the United States, of which nearly half of its residents are age 60 and older. Linear regression was used to associate the health clusters with perceptions of built environmental features and socio-demographics. Four distinct profiles were identified, with the greatest preference for housing and transportation found among those reporting poorer health compared to those reporting excellent health across multi-dimensional healthy aging measures. Perceptions on the importance of built environmental features were also found to vary by age, income and home accessibility status. Findings suggest that older adults' perceptions about built environmental features differ across health and home status as well as age and income, underscoring opportunities for public health action to better reach and engage older adults by life-course trajectories in age-friendly communities.

Generational Distinctions on the Importance of Age-Friendly Community Features by Older Age Groups.

In 2006, the World Health Organization initiated an international movement to enhance active aging and the age-friendliness of communities by focusing efforts on the built, social, and service environment. The global model requires soliciting older adults' preferences regarding community features although findings are typically aggregated across all aged respondents despite mounting distinctions between the generations. This study aimed to examine the differential salience of community features by older generational age groups including Baby Boomers (n = 639) and Silent and Government or General Issued (GI) Generation (n = 488) in an age-friendly community in which more than half of its residents are age 50 or older. Chi-square results indicate significant differences across the generational age groups in all domains with the greatest distinctions pertaining to preferences in housing, outdoor spaces, employment, and participation in varied social activities. The perceptions expressed by Boomer-aged adults portend implications ahead for multiple sectors and features of community life.

Community Gerontology: A Framework for Research, Policy, and Practice on Communities and Aging.

We introduce "community gerontology" as an area of research, policy, and practice that aims to advance understanding of communities as fundamental contexts for aging and its diversity, and to leverage this understanding for change. We present a foundational framework for community gerontology in three parts. First, we discuss the mesolevel as the unifying construct for community gerontology. Second, we describe community gerontology's focus on pathways of mutual influence between the mesolevel with more micro and macro contexts over time. Third, we put forth community gerontology's emphasis on gerontologists' participation in community change processes to facilitate more optimal experiences of aging among diverse population subgroups. We conclude by describing the integrative nature of community gerontology and the ways that this framework can advance research on particular substantive areas, as well as gerontology as a whole.

Measuring case managers' advance care planning practice: translating focus group findings to survey development.

Sequential mixed methods is a useful research design to inform second-stage methodology when investigating an area of practice in which relatively little is known. This article describes how focus group findings were used to measure advance care planning practice among community-based case managers. The initial qualitative study utilized focus groups to explore aspects of practice in this area. Data revealed themes that embodied ambiguous views of advance care planning, divergent roles in practice, a continuum of practice activities, and multiple facilitators and barriers to practice. In order to further examine case managers' advance care planning practices, qualitative findings were used to develop the Case Managers Advance Care Planning Practices Instrument. Implications for qualitative to quantitative measurement are discussed.

The promise of documentary theatre to counter ageism in age-friendly communities.

This paper discusses an innovative theatre-arts collaboration that was created to provoke public discourse about aging in a community located in the Southeastern United States in which more than one-half of residents are age 50 or older. The development and execution of the documentary theatre production are explicated and the post-performance talk-backs with the audience are shared to illustrate how it facilitated insight and dialogue among its largely older audiences. Experience with this production suggests that academics can collaborate with professional artists to promote the subjective experience of aging as a positive appreciation of self. Consequently, the play holds promise to counter deeply ingrained negative self-beliefs about aging and foster greater acceptance about the experience of others. In addition, the play represents a unique community-based effort to enhance respect and social inclusion, a core domain of livability in the age-friendly community movement.