Multimorbidity and depressive symptoms in older adults and the role of social support: Evidence using Canadian Longitudinal Study on Aging (CLSA) data.

BACKGROUND: The rising prevalence of multimorbidity poses challenges to health systems globally. The objectives of this study were to investigate: 1) the association between multimorbidity and depressive symptoms; and 2) whether social support plays a protective role in this association. METHODS: A prospective population-based cohort study was conducted to analyze baseline and 3-year follow-up data of 16,729 community dwelling participants aged 65 and above in the Canadian Longitudinal Study of Aging (CLSA). Multimorbidity was defined as having three or more chronic conditions. The 10-item Center for Epidemiologic Studies Depression scale (CESD-10) was used to measure depressive symptoms. The 19-item Medical Outcomes Study (MOS) Social Support Survey was employed to assess perceived social support. Multivariate logistic regression models were used to examine the association between multimorbidity, social support and depressive symptoms. RESULTS: Multimorbidity was very common among participants with a prevalence of 70.6%. Fifteen percent of participants had depressive symptoms at baseline. Multimorbidity was associated with increased odds of having depressive symptoms at 3-year follow-up (adjusted odds ratio, aOR = 1.51, 95% CI 1.33, 1.71), and developing depressive symptoms by follow-up among those with no depressive symptoms at baseline (aOR = 1.65, 95% CI 1.42, 1.92). Social support was consistently associated with decreased odds of depressive symptoms, regardless of level of multimorbidity. CONCLUSION: Multimorbidity was positively associated with depressive symptoms over time, but social support served as a protective factor. As a modifiable, protective factor, emphasis should be placed in clinical practice to assess social support and refer patients to appropriate services, such as support groups. Similarly, health policy should focus on ensuring that older adults have access to social support opportunities as a way to promote mental health among older adults. Community organizations that offer social activities or support groups play a key role in this respect and should be adequately supported (e.g., with funding).

Exploring the Sustainability of Age-Friendly Initiatives in a Canadian Province.

BACKGROUND AND OBJECTIVES: Based on the World Health Organization Age-Friendly Cities and Communities (AFCC) framework, the government of Manitoba, Canada, launched a province-wide age-friendly initiative in 2008. The objective of this study was to explore the sustainability of the AFCC initiative more than a decade later. The study was guided by conceptualizations of sustainability as multidimensional and dynamic, composed of 4 aspects (continued capacity, institutionalization, continued benefits, and development/adaptation), and an ecologic perspective that highlights the importance of contextual influences, and their change over time, on AFCC activities. RESEARCH DESIGN AND METHODS: The study involved a qualitative, multiple case study design. Semistructured interviews were conducted in 2020 with a key informant from each of 52 AFCC. Interview data were analyzed deductively, guided by the sustainability framework and an ecologic perspective. Census data were used to describe the demographic characteristics of AFCC. RESULTS: We identified 6 groups of AFCC initiatives that varied in degree from the most to the least sustainable: active, in hiatus, reorganized, stalled, discontinued, and never got off the ground. Both local community factors (e.g., lack of capacity) and broader contextual factors, such as demographic changes and provincial legislations, influenced initiatives' sustainability. DISCUSSION AND IMPLICATIONS: AFCC initiatives can range in their degree of sustainability and can wax or wane over time. Ongoing external support for AFCC (e.g., from provincial or state government) to promote the vision of age-friendliness and to address lack of capacity (e.g., to assist with community assessments) could help with the long-term sustainability of initiatives.

Design characteristics and inclusion of evidence-based exercise recommendation in fall prevention community exercise programs for older adults in Canada: a national descriptive self-report study.

BACKGROUND: Training balance through exercise is an effective strategy to reduce falls in community-dwelling older adults. Evidence-based fall prevention exercise recommendations have been proposed, specifying that exercise programs should: (1) provide a high challenge to balance, (2) be offered for a least three hours per week, (3) be provided on an ongoing basis. Community exercise programs have the potential to deliver effective fall prevention exercise; however, current design characteristics and whether they include the recommendations is not known. This study described design characteristics of fall prevention community exercise programs for older adults (50 years and older) across Canada, and explored whether these programs included the three evidence-based exercise recommendations. METHODS: Instructors of fall prevention community exercise programs completed electronic self-report questionnaires following a modified Dillman recruitment approach. Questions explored program characteristics, exercise content, target population, and program and instructor demographic information. Using a previously developed coding scheme based on recommendations, exercises were coded for balance challenge. RESULTS: One hundred fourty completed eligible questionnaires were analyzed (74% response rate). One hundred thirty-three programs (95%) included the challenge recommendation by prescribing mostly moderate or high challenge balance exercises, 16 programs (11%) included at least three hours of exercise a week, and 59 programs (42%) were offered on an ongoing basis. Eight programs (6%) included all three recommendations. CONCLUSIONS: Most programs included at least one recommendation for effective fall prevention exercise. Future studies should examine organizational barriers and facilitators to incorporating evidence-based exercise recommendations and explore the use of mixed home/in-class strategies to include the recommendations.

Age, Dementia, and Diagnostic Candidacy: Examining the Diagnosis of Young Onset Dementia Using the Candidacy Framework.

People living with young onset dementia face significant barriers to diagnosis, resulting in delays, misdiagnoses, and treatment gaps. We examined the process of accessing and delivering a diagnosis of young onset dementia using the candidacy framework as a conceptual lens. Semi-structured interviews were conducted with six people living with dementia, 14 family members, and 16 providers in a western Canadian city. Participants' accounts revealed the diagnosis of young onset dementia as a negotiated process involving patients, family members, and health professionals. Assumptions about age and dementia affected how participants interpreted their symptoms, how they presented to services, and how they, in turn, were perceived by providers. At the organizational level, age-restrictions, fragmentation, and unclear referral pathways further complicated the diagnostic process. Our findings lend support to the growing call for specialist young onset dementia care and point toward several recommendations to develop more age-inclusive diagnostic services.

Dancing With Dementia: Exploring the Embodied Dimensions of Creativity and Social Engagement.

BACKGROUND AND OBJECTIVES: Dance is increasingly being implemented in residential long-term care to improve health and function. However, little research has explored the potential of dance to enhance social inclusion by supporting embodied self-expression, creativity, and social engagement of persons living with dementia and their families. RESEARCH DESIGN AND METHODS: This was a qualitative sequential multiphase study of Sharing Dance Seniors, a dance program that includes a suite of remotely streamed dance sessions that are delivered weekly to participants in long-term care and community settings. Our analysis focused on the participation of 67 persons living with dementia and 15 family carers in residential long-term care homes in Manitoba, Canada. Data included participant observation, video recordings, focus groups, and interviews; all data were analyzed thematically. RESULTS: We identified 2 themes: playfulness and sociability. Playfulness refers to the ways that the participants let go of what is "real" and became immersed in the narrative of a particular dance, often adding their own style. Sociability captures the ways in which the narrative approach of the Sharing Dance Seniors program encourages connectivity/intersubjectivity between participants and their community; participants co-constructed and collaboratively animated the narrative of the dances. DISCUSSION AND IMPLICATIONS: Our findings highlight the playful and imaginative nature of how persons living with dementia engage with dance and demonstrate how this has the potential to challenge the stigma associated with dementia and support social inclusion. This underscores the urgent need to make dance programs such as Sharing Dance Seniors more widely accessible to persons living with dementia everywhere.

Exploring University Age-Friendliness Using Collaborative Citizen Science.

BACKGROUND AND OBJECTIVES: Since the launch of Dublin City University's Age-Friendly University (AFU) Initiative in 2012, relatively little empirical research has been published on its feasibility or implementation by institutions of higher learning. This article describes how collaborative citizen science-a research method where professional researchers and community members work together across multiple stages of the research process (e.g., data collection, analysis, and/or knowledge mobilization) to investigate an issue-was used to identify barriers and supports to university age-friendliness at the University of Manitoba (UofM) in Canada. RESEARCH DESIGN AND METHODS: Ten citizen scientists each completed 1 data collection walk around the UofM campus and used a tablet application to document AFU barriers and supports via photographs and accompanying audio commentaries. The citizen scientists and university researchers then worked together in 2 analysis sessions to identify AFU priority areas and brainstorm recommendations for institutional change. These were then presented to a group of interested university stakeholders. RESULTS: The citizen scientists collected 157 photos documenting AFU barriers and supports on campus. Accessibility, signage, and transportation were identified as being the most pressing issues for the university to address to improve overall age-friendliness. DISCUSSION AND IMPLICATIONS: We suggest that academic institutions looking to complete assessments of their age-friendliness, particularly those exploring physical barriers and supports, could benefit from incorporating older citizen scientists into the process of collecting, analyzing, and mobilizing findings.

Examining social isolation and loneliness in combination in relation to social support and psychological distress using Canadian Longitudinal Study of Aging (CLSA) data.

BACKGROUND: Although a large body of research has focused on social isolation and loneliness, few studies have examined social isolation and loneliness together. The objectives of this study were to examine: 1) the relationship between four groups derived from combining social isolation and loneliness (socially isolated and lonely; only socially isolated; only lonely; neither socially isolated nor lonely) and the desire for more social participation, and social support; and 2) the relationship between the four groups and psychological distress. METHODS: The study was based on the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Using CLSA baseline data (unweighted N = 30,079), ordinary and logistic regression analysis was used to examine the cross-sectional relationship between the four social isolation/loneliness groups and desire for more social participation and four types of social support (tangible, positive interaction, affection, and emotional support). Prospective logistic regression analysis was possible for psychological distress, which was derived from the Maintaining Contact Questionnaire administered about 18 months after the baseline questionnaire (unweighted N = 28,789). RESULTS: Findings indicate that being socially isolated and lonely was associated with the most social support gaps; this group also had an increased likelihood of psychological distress, relative to those who were neither socially isolated nor lonely. Participants who were only socially isolated, and those only lonely also perceived some social support gaps. In addition, the only lonely group was more likely to be psychologically distressed than the only socially isolated group and the neither isolated nor lonely group. CONCLUSION: Examining the four social isolation/loneliness was useful, as it provided more nuanced risk profiles than would have been possible had we examined social isolation and loneliness separately. Findings may suggest avenues for interventions tailored to the unique needs of at-risk individuals.

Examining individual and geographic factors associated with social isolation and loneliness using Canadian Longitudinal Study on Aging (CLSA) data.

BACKGROUND: A large body of research shows that social isolation and loneliness have detrimental health consequences. Identifying individuals at risk of social isolation or loneliness is, therefore, important. The objective of this study was to examine personal (e.g., sex, income) and geographic (rural/urban and sociodemographic) factors and their association with social isolation and loneliness in a national sample of Canadians aged 45 to 85 years. METHODS: The study involved cross-sectional analyses of baseline data from the Canadian Longitudinal Study on Aging that were linked to 2016 census data at the Forward Sortation Area (FSA) level. Multilevel logistic regression analyses were conducted to examine the association between personal factors and geographic factors and social isolation and loneliness for the total sample, and women and men, respectively. RESULTS: The prevalence of social isolation and loneliness was 5.1% and 10.2%, respectively, but varied substantially across personal characteristics. Personal characteristics (age, sex, education, income, functional impairment, chronic diseases) were significantly related to both social isolation and loneliness, although some differences emerged in the direction of the relationships for the two measures. Associations also differed somewhat for women versus men. Associations between some geographic factors emerged for social isolation, but not loneliness. Living in an urban core was related to increased odds of social isolation, an effect that was no longer significant when FSA-level factors were controlled for. FSAs with a higher percentage of 65+ year old residents with low income were consistently associated with higher odds of social isolation. CONCLUSION: The findings indicate that socially isolated individuals are, to some extent, clustered into areas with a high proportion of low-income older adults, suggesting that support and resources could be targeted at these areas. For loneliness, the focus may be less on where people live, but rather on personal characteristics that place individuals at risk.

The effect of time perspectives on mental health information processing and help-seeking attitudes and intentions in younger versus older adults.

Socioemotional selectivity theory posits that changes in time perspective over the lifespan are associated with distinct goals and motivations. Time perspectives and their associated socioemotional motivations have been shown to influence information processing and memory, such that motivation-consistent information is more likely to be remembered and evaluated more positively. OBJECTIVE: The aim of this study was to examine the effect of motivation-consistent mental health information on memory for and evaluations of this information, as well as help-seeking attitudes and intentions to seek mental health services. METHOD: We randomly assigned an Internet-based sample of 160 younger (18-25) and 175 older (60-89) adults to read a mental health information pamphlet that emphasized time perspectives and motivations relevant to either young adulthood (future-focused) or late adulthood (present-focused). Participants completed measures assessing their time perspective, memory for and subjective evaluation of the pamphlet, and help-seeking attitudes and intentions. RESULTS: The time perspective manipulation had no effect on memory for pamphlet information or help-seeking attitudes and intentions. There was, however, a significant interaction between time perspective and pamphlet version on the rated liking of the pamphlet. CONCLUSION: Although motivation-consistent information only affected perceptions of that information for present-focused (mostly older) individuals, this finding has important implications for enhancing older adults' mental health literacy.

Rural residence and risk of dementia.

INTRODUCTION: We sought to determine whether residence in a rural region is associated with a higher risk of dementia and a higher risk of developing dementia over a 5-year period than residence in an urban region. METHODS: This was a secondary analysis of a prospective cohort study. In 1991 and 1992, 1751 adults aged 65 years and older and residing in the community were sampled from a representative population-based registry, which included the entire province (time 1). Follow-up occurred 5 years later (time 2). Age, sex and education were selfreported. Rurality was determined by the population of the Census subdivision, with a population greater than 19 999 considered urban. Cognition was assessed using the Modified Mini-Mental State Examination, with those scoring below 78 invited to undergo a clinical examination to determine the presence of dementia. Cross-sectional analyses were conducted for participants with complete data at time 1. Prospective analyses were conducted for participants with normal cognition at time 1, who had complete data and survived until time 2. Logistic regression models were constructed for the outcome of dementia at times 1 and 2. RESULTS: Residence in a rural region was not associated with dementia in the cross-sectional analyses (adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 0.61-1.91) and did not predict dementia 5 years later (adjusted OR 1.05, 95% CI 0.66-1.68). CONCLUSION: We found no difference in the risk of dementia among older adults living in urban and rural regions of Manitoba.

INTRODUCTION: Nous avons voulu déterminer si le fait de vivre en milieu rural est associé à un risque plus élevé de démence et à un risque plus élevé de développer une démence sur une période de 5 ans, comparativement au fait de vivre en milieu urbain. METHODS: Il s'agit de l'analyse secondaire d'une étude de cohorte prospective. En 1991 et 1992, 1751 adultes de 65 ans ou plus vivant dans la communauté ont été échantillonnés à partir d'un registre représentatif de la population de toute la province (période 1). Un suivi a été effectué 5 ans plus tard (période 2). L'âge, le sexe et la scolarité étaient autodéclarés, et la ruralité était déterminée à partir des subdivisions utilisées aux fins de recensement : une population de 19 999 personnes ou plus était réputée urbaine. La cognition a été évaluée au moyen d'une version modifiée du mini-examen de l'état mental, et les sujets qui obtenaient un score inférieur à 78 étaient invités à subir un examen clinique pour déterminer la présence de démence. Des analyses transversales ont été réalisées pour les participants au sujet desquels on disposait de données complètes lors de la période 1. Des analyses prospectives ont été réalisées pour les participants dont la cognition était normale à la période 1, au sujet desquels on disposait de données complètes et qui avaient survécu jusqu'à la période 2. Des modèles de régression logistique ont été élaborés pour le paramètre de démence aux périodes 1 et 2. RESULTS: Le fait de vivre en région rurale n'a pas été associé à la démence selon les analyses transversales (rapport des cotes [RC] ajusté 1,08, intervalle de confiance [IC] de 95 % 0,61­1,91) et ne s'est pas révélé prédicteur de la démence 5 ans plus tard (RC ajusté 1,05, IC de 95 % 0,66­1,68). CONCLUSION: Nous n'avons observé aucune différence pour ce qui est du risque de démence chez les adultes âgés du Manitoba, qu'ils vivent en milieu rural ou urbain.

General life satisfaction predicts dementia in community living older adults: a prospective cohort study.

BACKGROUND: Low life satisfaction predicts adverse outcomes, and may predict dementia. The objectives were: (1) to determine if life satisfaction predicts dementia over a five year period in those with normal cognition at baseline; and (2) to determine if different aspects of life satisfaction differentially predict dementia. METHODS: Secondary analysis of an existing population-based cohort study with initial assessment in 1991 and follow-up five years later. Initially, 1,751 adults age 65+ living in the community were sampled from a representative sampling frame. Of these, 1,024 were alive and had complete data at time 2, of whom 96 were diagnosed with dementia. Life satisfaction was measured using the Terrible-Delightful scale, which measures overall life satisfaction on a 7-point scale, as well as various aspects of life satisfaction (e.g. friendships, finances, etc.) Dementia was diagnosed by clinical examination using DSM-IIIR criteria. Logistic regression models were constructed for the outcome of dementia at time 2, and adjusted for age, gender, education, and comorbidities. RESULTS: Overall life satisfaction predicted dementia five years later, at time 2. The unadjusted Odds Ratio (OR; 95% confidence interval) for dementia at time 2 was 0.72 (0.55, 0.95) per point. The adjusted OR for dementia was 0.70 (0.51, 0.96). No individual item on the life satisfaction scale predicted dementia. However, the competing risk of mortality was very high for some items. CONCLUSION: A global single-item measure of life satisfaction predicts dementia over a five year period in older adults without cognitive impairment.

Comparing the Overall Health, Stress, and Characteristics of Canadians with Early-Onset and Late-Onset Dementia.

OBJECTIVE: Dementia is increasingly recognized as a public health priority, but little is known about persons with early-onset dementia (EOD). The objectives of this article are (a) to compare the socio-demographic and health characteristics of people with EOD and late-onset dementia (LOD) and (b) to examine the relationships between EOD and overall health and life stress. METHOD: Data were from the Survey on Living With Neurological Conditions in Canada (SLNCC). Logistic regression models were used to identify the characteristics associated with EOD and LOD, and to assess the impact of EOD on overall health and life stress. RESULTS: Compared with LOD, individuals with EOD were more likely to be male, to have a mood disorder, and to have a longer illness duration. EOD was associated with high life stress, but not with negative overall health. DISCUSSION: This study identified attributes associated with EOD that have important implications for service planning.

Assessing Communities' Age-Friendliness: How Congruent Are Subjective Versus Objective Assessments?

The notion of age-friendliness is gaining increasing attention from policy makers and researchers. In this study, we examine the congruence between two types of age-friendly surveys: subjective assessments by community residents versus objective assessments by municipal officials. The study was based on data from 39 mostly rural communities in Manitoba, Canada, in which a municipal official and residents (M= 25 residents per community) completed a survey to assess age-friendly features in a range of domains, such as transportation and housing. Congruence between the two surveys was generally good, although the municipal official survey consistently overestimated communities' age-friendliness, relative to residents' ratings. The findings suggest that a survey completed by municipal officials can provide a reasonable assessment of age-friendliness that may be useful for certain purposes, such as cross-community comparisons. However, some caution is warranted when using only these surveys for community development, as they may not adequately reflect residents' views.

How Important Is Having Amenities Within Walking Distance to Middle-Aged and Older Adults, and Does the Perceived Importance Relate to Walking?

OBJECTIVE: This study examined how important walking to amenities (e.g., food store, park) is to middle-aged and older adults and whether this relates to walking. The relationship between walking to amenities and overall activity level was also explored. METHOD: The study was based on interviews conducted with 778 individuals aged 45 to 94 years. Overall activity level was measured objectively using pedometers. RESULTS: A large proportion of participants did not think it was very important to have amenities within walking distance, and the majority of participants drove to get there, even among individuals who reported it was very important to have the amenities within walking distance. Self-reported walking to certain amenities (e.g., park) was associated with overall activity. DISCUSSION: The study underscores the impact of a car culture where the tendency to drive is paramount. It suggests the need to promote the importance of walking as part of an active, healthy lifestyle.

A longitudinal examination of social participation, loneliness, and use of physician and hospital services.

OBJECTIVE: This study examined whether social participation and loneliness predicted health care service use (physician visits, hospitalizations, length of stay in hospital). METHOD: Participants' (N = 954; 54% female; aged 45+ years) health data were tracked over 2.5 years following in-person interviews. RESULTS: Being lonely was associated with greater number of physician visits, though this relationship was mediated by health. Neither loneliness nor social participation was associated with admission to hospital. However, for those who were hospitalized at least once over 2.5 years, being lonely was associated with a higher odds of being re-hospitalized; furthermore, greater social participation was associated with a lower odds of being in the hospital for an extended duration. These relationships held even when controlling for initial health. DISCUSSION: Results provide evidence, using objective health care data, of the potential importance of social factors in predicting adults' physician visits, re-hospitalization, and length of stay in hospital.

What community characteristics help or hinder rural communities in becoming age-friendly? Perspectives from a Canadian prairie province.

Age-friendly initiatives are increasingly promoted as a policy solution to healthy aging, The primary objective of this article was to examine older adults' and key stakeholders' perceptions of the factors that either help or hinder a community from becoming age-friendly in the context of rural Manitoba, a Canadian prairie province. Twenty-four older adults and 17 key informants completed a qualitative interview. The findings show that contextual factors including size, location, demographic composition, ability to secure investments, and leadership influence rural communities' ability to become age-friendly. Government must consider the challenges these communities face in becoming more age-friendly and develop strategies to support communities.

Targeting Socially Isolated Older Adults: A Process Evaluation of the Senior Centre Without Walls Social and Educational Program.

The Seniors Centre Without Walls (SCWOW) program provides free social and educational programming for older adults via telephone. The target population for SCWOW is socially isolated older adults, a hard to reach population. The aim of this process evaluation was to examine whether SCWOW was reaching its target population and to gather participant feedback about program implementation and the perceived satisfaction and impact of the program. Telephone interviews were conducted with 26 participants (92% females; aged 57-85 years). Forty-two percent of the sample was socially isolated and more than half reported being lonely. Participants reported having no difficulty using the telephone system. On average, participants were very satisfied with the program and reported that SCWOW had several positive effects (e.g., connecting to the larger community, affecting mental well-being). Importantly, no barriers to participation were identified. The study suggests that telephone-based programs can successfully reach socially isolated older adults.

Relationship of functional fitness with daily steps in community-dwelling older adults.

BACKGROUND: Walking is the main type of physical activity among community-dwelling older adults and it is associated with various health benefits. However, there is limited evidence about the relationship between functional fitness and walking performed under independent living conditions among older adults. PURPOSE: This study examined the relationship between functional fitness and steps walked per day among older adults, both assessed objectively, with performance-based measures accounting for the effect of age, gender, and chronic conditions. METHODS: In this cross-sectional study, 60 participants aged 65 years or older (mean = 76.9 ± 7.3 years, range 65-92 years) wore pedometers for 3 consecutive days. Functional fitness was measured using the Functional Fitness Test (lower and upper body strength, endurance, lower and upper body flexibility, agility/balance). The outcome measure was the mean number of steps walked for 3 days with participants classified into tertiles: low walkers (<3000 steps), medium walkers (≥3000 < 6500 steps), and high walkers (≥6500 steps). RESULTS: After controlling for age, gender, and the number of chronic conditions, none of the functional fitness parameters was significantly associated with steps taken per day when comparing medium walkers with low walkers. In contrast, all functional fitness parameters, except upper body flexibility, were significantly associated with steps taken per day when comparing high walkers with low walkers. CONCLUSION: In this sample of older adults, greater functional fitness was associated only with relatively high levels of walking involving 6500 steps per day or more. It was not related to medium walking levels. The findings point to the importance of interventions to maintain or enhance functional fitness among older adults.

Examining the relationship between communities' 'age-friendliness' and life satisfaction and self-perceived health in rural Manitoba, Canada.

INTRODUCTION: Population aging is a worldwide phenomenon. As a response, the World Health Organization (WHO) introduced the concept of 'age-friendliness' in 2006. Age-friendliness is defined in terms of a range of domains, such as housing, opportunities for participation, and transportation. Communities that accommodate the needs of older adults in these domains will, it is thought, promote healthy, active aging. The purpose of the present study was to examine communities' age-friendliness and its relationship to health-related outcomes in a rural context. METHODS: The study included 29 communities located in Manitoba, a mid-Western Canadian province, that are part of the Province of Manitoba's Age-Friendly Manitoba Initiative. As part of a needs assessment process in these communities, 593 individuals, including seniors and younger adults, completed an Age-Friendly Survey. The survey was designed to measure a variety of features in seven domains (the physical environment, housing options, the social environment, opportunities for participation, community supports and healthcare services, transportation options, and communication and information), as well as containing measures of life satisfaction and self-perceived health. Community characteristics were derived from census data. Moreover, communities were categorized on a rural-urban continuum. RESULTS: Multi-level regressions indicated that an overall Age-Friendly Index was positively related to both life satisfaction (b=0.019, p<0.0001) and self-perceived health (b=0.013, p<0.01). When examining more specifically each of the seven age-friendly domains, all but housing was positively related to life satisfaction. Results were not as consistent for self-perceived health, with significant relationships emerging only for the physical environment, social environment, opportunities for participation, and transportation options. A subsequent analysis for seniors versus younger participants, respectively, indicated that significant relationships between age-friendly domains and life satisfaction and self-perceived health were restricted primarily to seniors. None of the community characteristics were related to life satisfaction and self-perceived health, nor was degree of rurality. CONCLUSIONS: The concept of age-friendliness has been garnering considerable attention from policy-makers as a way to promote healthy aging. For example, in Canada, several provinces have launched age-friendly initiatives. Although causality cannot be inferred from the present, cross-sectional study, the findings are encouraging as they show that age-friendliness is associated with enhanced life satisfaction and self-perceived health in a rural context. The study further supports the notion that a wide range of domains within the community environment are important in older adults' lives and need to be considered. Public policy initiatives, such as the Province of Manitoba's Age-Friendly Initiative, may thus be one approach to enhancing healthy aging in rural settings.