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

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

How Should Organizations Be Held Accountable for Promoting Environments That Foster Social Connection?

Growing familiarity with health risks of loneliness and isolation underscores the importance of social connection in patients' lived environments and communities. Deficits in social connection are linked to poor cognitive, mental, and physical health and premature death. Design interventions for physical environments-structures, spaces, and soundscapes, for example-can foster social connection, support, and resilience. This article canvasses urban interventions that can support human health investment and development. This article also suggests that designers of community policies, programs, structures, and spaces should be accountable for promoting social connection to help generate measurable health outcomes, such as longevity.

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention.

Decisions made in health care architecture have profound effects on patients, families, and staff. Drawing on research in medicine, neuroscience, and psychology, design is being used increasingly often to alter specific behaviors, mediate interpersonal interactions, and affect patient outcomes. As a result, the built environment in health care should in some instances be considered akin to a medical intervention, subject to ethical scrutiny and involving protections for those affected. Here we present two case studies. The first includes work aimed at manipulating the behavior of persons with neurocognitive impairments, often in long-term care facilities. This is done to ensure safety and minimize conflicts with staff, but it raises questions about freedom, consent, and disclosure. The second concerns design science in service of improved outcomes, which involves research on improving patient outcomes or the performance of health care teams. There is evidence that in some ICU designs, certain rooms correlate to better outcomes, giving rise to questions about equity and fairness. In other cases, a facility's architecture seems to be putting a finger on the scale of equipoise, raising questions about the intentionality of clinical judgment, freedom of choice, and disclosure. As a result of this innovation occurring outside the boundaries of traditional care delivery and oversight, important ethical questions emerge concerning both the individual patient and patient populations. We discuss, analyze, and make recommendations about each and suggest future directions for these and related issues.

Calibration Bias and the Interpretation of Clinical Learning Environment Perceptions Surveys.

BACKGROUND: The clinical learning environment (CLE) is frequently assessed using perceptions surveys, such as the AAMC Graduation Questionnaire and ACGME Resident/Fellow Survey. However, these survey responses often capture subjective factors not directly related to the trainee's CLE experiences. OBJECTIVE: The authors aimed to assess these subjective factors as "calibration bias" and show how it varies by health professions education discipline, and co-varies by program, patient-mix, and trainee factors. METHODS: We measured calibration bias using 2011-2017 US Department of Veterans Affairs (VA) Learners' Perceptions Survey data to compare medical students and physician residents and fellows (n = 32 830) with nursing (n = 29 758) and allied and associated health (n = 27 092) trainees. RESULTS: Compared to their physician counterparts, nursing trainees (OR 1.31, 95% CI 1.22-1.40) and allied/associated health trainees (1.18, 1.12-1.24) tended to overrate their CLE experiences. Across disciplines, respondents tended to overrate CLEs when reporting 1 higher level (of 5) of psychological safety (3.62, 3.52-3.73), 1 SD more time in the CLE (1.05, 1.04-1.07), female gender (1.13, 1.10-1.16), 1 of 7 lower academic level (0.95, 1.04-1.07), and having seen the lowest tercile of patients for their respective discipline who lacked social support (1.16, 1.12-1.21) and had low income (1.05, 1.01-1.09), co-occurring addictions (1.06, 1.02-1.10), and mental illness (1.06, 1.02-1.10). CONCLUSIONS: Accounting for calibration bias when using perception survey scores is important to better understand physician trainees and the complex clinical learning environments in which they train.