Global Age Friendly Cities Guide English

Global Age-friendly Cities:
A Guide

AGEING AND LIFE COURSE, FAMILY AND COMMUNITY HEALTH

Global Age-friendly Cities:
A Guide

WHO Library Cataloguing-in-Publication Data
Global age-friendly cities : a guide.

1.Aged - statistics. 2.Aging. 3.Urban health. 4.City planning. 5.Residence characteristics. 6.Quality of life.
7.Consumer participation. 8.Strategic planning. I.World Health Organization.

ISBN 978 92 4 154730 7 (NLM classiﬁcation: WT 31)

© World Health Organization 2007

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PAGE iI


Table of Contents

Acknowledgements iv

Introduction: about this Guide 1

Part 1. Global ageing and urbanization: meeting the challenge of 3
humanity’s success

Part 2. Active ageing: a framework for age-friendly cities 5

Part 3. How the Guide was developed 7

Part 4. How to use the Guide 11

Part 5. Outdoor spaces and buildings 12

Part 6. Transportation 20

Part 7. Housing 30

Part 8. Social participation 38

Part 9. Respect and social inclusion 45

Part 10. Civic participation and employment 51

Part 11. Communication and information 60

Part 12. Community support and health services 66

Part 13. Wrapping up and moving forward 72

References 76

PAGE iII

Acknowledgements
This project was conceived in June 2005 at the opening session of the XVIII IAGG World Congress of
Gerontology and Geriatrics in Rio de Janeiro, Brazil. It immediately attracted enthusiastic interest, which
has translated into generous contributions from many partners. We gratefully acknowledge the funding and
in-kind support provided by the Public Health Agency of Canada, which was crucial for implementing the
research, the participation of several cities and the publication of this Guide.

We also extend our appreciation to the Ministry of Health of British Columbia for supporting the initial
meeting of collaborating cities in May, 2006 in Vancouver, Canada; to 2010 Legacies Now for funding the
publication of a promotional pamphlet; to Help the Aged for enabling the participation of two cities and for
supporting the second meeting of collaborating cities in London, United Kingdom, in March 2007; and to the
City of Ottawa, Canada, for pilot testing the research protocol. The implementation of the research project
and attendance at project meetings was made possible by government and local funding in most of the col-
laborating cities.

The project benefited at all phases from the guidance of an advisory group, the members of which we warm-
ly thank: Margaret Gillis, Public Health Agency of Canada; James Goodwin, Help the Aged, United Kingdom;
Tessa Graham, Ministry of Health of British Columbia, Canada; Gloria Gutman, Simon Fraser University,
Canada; Jim Hamilton, Healthy Aging Secretariat of Manitoba, Canada; Nabil Kronful, Lebanese Healthcare
Management Association, Lebanon; Laura Machado, Inter-Age Consulting in Gerontology, Brazil; and Elena
Subirats-Simon, Acción para la Salud, Mexico.

The Global Age-Friendly Cities project was developed by Alexandre Kalache and Louise Plouffe, WHO head-
quarters, Geneva, Switzerland, and the report was produced under their overall direction. Substantial intel-
lectual contributions in the data analysis and preparation of the report were made by Louise Plouffe; Karen
Purdy, Office for Seniors Interests and Volunteering, Government of Western Australia; Julie Netherland, Ana
Krieger and Ruth Finkelstein, New York Academy of Medicine; Donelda Eve, Winnie Yu and Jennifer MacKay,
Ministry of Health of British Columbia; and Charles Petitot, WHO headquarters.

The research protocol was implemented in the following 33 cities thanks to the efforts of governments,
nongovernmental organizations and academic groups:

Amman, Jordan La Plata, Argentina New Delhi, India San José, Costa Rica
Cancún, Mexico London, United Ponce, Puerto Rico Shanghai, China
Dundalk, Ireland Kingdom Portage la Prairie, Sherbrooke, Canada
Geneva, Switzerland Mayaguez, Puerto Rico Canada Tokyo, Japan
Halifax, Canada Melbourne, Australia Portland, Oregon, Tripoli, Lebanon
Himeji, Japan Melville, Australia United States of America Tuymazy, Russian
Islamabad, Pakistan Mexico City, Mexico Rio de Janeiro, Brazil Federation
Istanbul, Turkey Moscow, Russian Ruhr metropolitan Udaipur, India
Kingston and Montego Federation region, Germany Udine, Italy
Bay (combined), Jamaica Nairobi, Kenya Saanich, Canada

Finally, special gratitude is expressed to the older people in all research locations, as well as to the caregiv-
ers and service providers who were also consulted in many sites. In focus groups, these people articulated
the model of an age-friendly city based on their experience that is at the heart of this Guide. These older
people and those who interact with them in significant ways will continue to play a critical role as commu-
nity advocates and overseers of action to make their cities more age-friendly.

PAGE iV


Introduction: about this Guide

Population ageing and urbanization are and barriers they experience in eight areas
two global trends that together comprise of city living. In most cities, the reports
major forces shaping the 21st century. At from older people were complemented by
the same time as cities are growing, their evidence from focus groups of caregivers
share of residents aged 60 years and more is and service providers in the public, volun-
increasing. Older people are a resource for tary and private sectors. The results from
their families, communities and economies the focus groups led to the development of
in supportive and enabling living environ- a set of age-friendly city checklists.
ments. WHO regards active ageing as a life-
• Part 1 describes the converging trends
long process shaped by several factors that,
of rapid growth of the population over
alone and acting together, favour health,
60 years of age and of urbanization, and
participation and security in older adult
outlines the challenge facing cities.
life. Informed by WHO’s approach to ac-
tive ageing, the purpose of this Guide is to • Part 2 presents the “active ageing” con-
engage cities to become more age-friendly cept as a model to guide the development
so as to tap the potential that older people of age-friendly cities.
represent for humanity.
• Part 3 summarizes the research process
An age-friendly city encourages active age- that led to identifying the core features of
ing by optimizing opportunities for health, an age-friendly city.
participation and security in order to en- • Part 4 describes how the Guide should be
hance quality of life as people age. used by individuals and groups to stimu-
late action in their own cities.
In practical terms, an age-friendly city
adapts its structures and services to be • Parts 5–12 highlight the issues and con-
accessible to and inclusive of older people cerns voiced by older people and those
with varying needs and capacities. who serve older people in each of eight
areas of urban living: outdoor spaces and
To understand the characteristics of an buildings; transportation; housing; social
age-friendly city, it is essential to go to participation; respect and social inclu-
the source – older city dwellers. By work- sion; civic participation and employment;
ing with groups in 33 cities in all WHO communication and information; and
regions, WHO has asked older people in community support and health services.
focus groups to describe the advantages In each part, the description of the ﬁnd-
ings concludes with a checklist of core
age-friendly city features obtained by
analysing the reports from all cities.

PAGE 1

• Part 13 integrates the ﬁndings within undertaking initiatives to translate the
the WHO active ageing perspective and research into local action, to expand the
highlights strong connections between the scope beyond cities, and to spread it to
age-friendly city topics. These reveal the more communities. An age-friendly com-
principal traits of the “ideal” age-friendly munity movement is growing for which
city and show how changing one aspect this Guide is the starting point.
of the city can have positive eﬀects on the
lives of older people in other areas. Seized
by the promise of more age-friendly com-
munities, WHO collaborators are now

PAGE 2


Part 1. Global ageing and urbanization:
meeting the challenge of
humanity’s success
The world is rapidly ageing: the number of that is, cities with 10 million inhabitants or
people aged 60 and over as a proportion of more, increased tenfold from 2 to 20 during
the global population will double from 11% the 20th century, accounting for 9% of the
in 2006 to 22% by 2050. By then, there will world’s urban population by 2005 (4). The
be more older people than children (aged number and proportion of urban dwellers
0–14 years) in the population for the first will continue to rise over the coming de-
time in human history (1). Developing coun- cades, and particularly in cities with fewer
tries are ageing at a much faster rate than than five million inhabitants (5). Again, this
developed countries: within five decades, growth is happening much more rapidly in
just over 80% of the world’s older people will developing regions. By 2030, about three
be living in developing countries compared out of every five people in the world will live
with 60% in 2005 (2). in cities and the number of urban dwellers
in the less developed regions will be almost
At the same time, our world is a growing
four times as large as that in the more devel-
city: as of 2007, over half of the global popu-
oped regions (Fig. 2) (6).
lation now lives in cities (3). Mega-cities,

Figure 1. Percent distribution of world population 60 or over by region, 2006 and 2050

35 34 2006
2050
30
27
25
25 24 24
21
Percent

20
17
15 14
10
10 9 9
9
5

0
Africa Asia Europe Latin North Oceania
America America
and the
Caribbean

Source: United Nations Department of Economic and Social Affairs (1).

PAGE 3

Figure 2. Percentage of Urban Population in Major Areas

100 2005
87 2030
84.3
78.3 77.4 80.8
80 73.8
72.2 70.8
59.9
60
Percent

54.1
48.7 50.7

38.3 39.8
40

20

0
World Africa Asia Europe Latin North Oceania
America America
and the
Caribbean

Source: United Nations Department of Economic and Social Affairs, Population Division (6).

More older people are also living in cities. economy”. Urban growth is associated with a
The proportion of the older adult popula- country’s technological and economic devel-
tion residing in cities in developed coun- opment. Vibrant cities beneﬁt a country’s en-
tries matches that of younger age groups at tire population – urban and rural. Because
about 80%, and will rise at the same pace. cities are the centre of cultural, social and
In developing countries, however, the share political activity, they are a hothouse for new
of older people in urban communities will ideas, products and services that inﬂuence
multiply 16 times from about 56 million in other communities and therefore the world.
1998 to over 908 million in 2050. By that Yet to be sustainable, cities must provide
time, older people will comprise one fourth the structures and services to support their
of the total urban population in less devel- residents’ wellbeing and productivity. Older
oped countries (7). people in particular require supportive and
enabling living environments to compensate
Population ageing and urbanization are the
for physical and social changes associated
culmination of successful human develop-
with ageing. This necessity was recognized
ment during last century. They also are ma-
as one of the three priority directions of
jor challenges for this century. Living longer
the Madrid International Plan of Action on
is the fruit of critical gains in public health
Ageing endorsed by the United Nations in
and in standards of living. As stated in the
2002 (9). Making cities more age-friendly is
WHO Brasilia Declaration on Ageing (8) in
a necessary and logical response to promote
1996, “healthy older people are a resource
the wellbeing and contributions of older ur-
for their families, their communities and the
ban residents and keep cities thriving. And

PAGE 4


Part 2. Active ageing:
a framework for age-friendly cities
The idea of an age-friendly city presented in • protecting those who are most vulner-
this Guide builds on WHO’s active ageing able; and
framework (10).
• promoting their inclusion in and contri-
Active ageing is the process of optimizing bution to all areas of community life.
opportunities for health, participation and Active ageing depends on a variety of influ-
security in order to enhance quality of life ences or determinants that surround indi-
as people age. viduals, families and nations. They include
material conditions as well as social factors
In an age-friendly city, policies, services,
that affect individual types of behaviour
settings and structures support and enable
and feelings (11). All of these factors, and
people to age actively by:
the interaction between them, play an im-
• recognizing the wide range of capacities portant role in affecting how well individu-
and resources among older people; als age. Many aspects of urban settings and
services reflect these determinants and are
• anticipating and responding flexibly to
included in the characteristic features of an
ageing-related needs and preferences;
age-friendly city (Fig. 3).
• respecting their decisions and lifestyle
choices;

Figure 3. Determinants of Active Ageing

Gender
Health and
Economic social services
determinants

Behavioural
Active determinants
Social Ageing
determinants

Personal
determinants
Physical
environment

Culture

PAGE 5

These determinants have to be understood Because active ageing is a lifelong process,
from a life course perspective that recog- an age-friendly city is not just “elderly-
nizes that older people are not a homoge- friendly”. Barrier-free buildings and streets
neous group and that individual diversity enhance the mobility and independence of
increases with age. This is expressed in Fig. people with disabilities, young as well as
4, which illustrates that functional capacity old. Secure neighbourhoods allow children,
(such as muscular strength and cardiovas- younger women and older people to venture
cular output) increases in childhood, peaks outside in confidence to participate in physi-
in early adulthood and eventually declines. cally active leisure and in social activities.
The rate of decline is largely determined by Families experience less stress when their
factors related to lifestyle, as well as external older members have the community support
social, environmental and economic factors. and health services they need. The whole
From an individual and societal perspective, community benefits from the participation
it is important to remember that the speed of older people in volunteer or paid work.
of decline can be influenced and may be Finally, the local economy profits from the
reversible at any age through individual and patronage of older adult consumers. The
public policy measures, such as promoting operative word in age-friendly social and
an age-friendly living environment. physical urban settings is enablement.

Figure 4. Maintaining functional capacity over the life course

Early Life Adult Life Older Age
Growth and Maintaining highest Maintaining independence
development possible level of function andpreventing disability
Functional Capacity

Rang
e
in ind of functio
ividu n
als

Disability threshold*

Rehabilitation and ensuring
the quality of life

Age

Source: Kalache & Kickbusch (12).

PAGE 6


Part 3. How the Guide was developed

Cities in all WHO Regions each city have involved older people as full
participants in the project. Project leaders
A total of 35 cities from all continents par-
sought the first-hand experience of older
ticipated in the WHO project leading to the
people. What are the age-friendly features
Guide, and 33 of these cities participated in
of the city they live in? What problems do
focus group research thanks to the collabo-
they encounter? What is missing from the
ration of government officials and nongov-
city that would enhance their health, par-
ernmental and academic groups (1). These
ticipation and security?
cities represent a wide range of developed
and developing countries (Fig. 5). They Focus groups were set up with older people
reflect the diversity of contemporary urban aged 60 years and older from lower- and
settings, including six current mega-cities middle-income areas. A total of 158 such
with over 10 million inhabitants (Mexico groups, involving 1485 participants, were
City, Moscow, New Delhi, Rio de Janeiro, organized between September 2006 and
Shanghai and Tokyo), “almost mega-cities” April 2007. Older people were the main
such as Istanbul, London and New York, as source of information in all the 33 cities
well as national capitals, regional centres that conducted focus groups. To obtain the
and small cities. views of people who would be unable to
attend focus groups owing to physical or
Bottom-up participatory approach mental impairment, most cities also held
The bottom-up participatory approach a focus group with caregivers who talked
(13) involves older people in analysing and about the experience of the older people for
expressing their situation to inform govern- whom they were caring.
ment policies. It is recommended by the
To complement the information from
United Nations for empowering older peo-
older people and caregivers, most cities
ple to contribute to society and to partici-
also conducted focus groups with service
pate in decision-making processes. Because
providers from the public, voluntary and
older people are the ultimate experts on
commercial sectors. In all, 250 caregivers
their own lives, WHO and its partners in
and 515 service providers were included in
the consultations. These people made ob-
1. Edinburgh contributed information on the city’s age- servations based on their interactions with
friendliness, based on a large survey and individual
interviews collected a few months prior to the WHO
older people. The caregivers and service
project. The information from Edinburgh, using a dif- providers sometimes provided information
ferent but complementary methodology, provided ad-
ditional confirmation of the findings from focus groups.
that older people did not report, but the
New York City was closely involved in the data analysis information from both groups was always
and in the development of the next phases of the Global
Age-Friendly Cities project.
consistent with the views expressed by

PAGE 7

Figure 5. World map of age-friendly partner cities

Americas Africa UK, Edinburgh
Argentina, La Plata Kenya, Nairobi UK, London
Brazil, Rio de Janeiro
Canada, Halifax Eastern Mediterranean South-east Asia
Canada, Portage la Prairie Jordan, Amman India, New Delhi
Canada, Saanich Lebanon, Tripoli India, Udaipur
Canada, Sherbrooke Pakistan, Islamabad
Costa Rica, San Jose Western Pacific
Jamaica, Kingston Europe Australia, Melbourne
Jamaica, Montego Bay Germany, Ruhr Australia, Melville
Mexico, Cancun Ireland, Dundalk China, Shanghai
Mexico, Mexico City Italy, Udine Japan, Himeji
Puerto Rico, Mayaguez Russia, Moscow Japan, Tokyo
Puerto Rico, Ponce Russia, Tuymazy
USA, New York Switzerland, Geneva
USA, Portland Turkey, Istanbul

The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the
World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers
or boundaries. Dashed lines represent approximate border lines for which there may not yet be full agreement.

older people. structures, environment, services and poli-
cies that reﬂect the determinants of active
Discussion topics ageing. The topics had been identiﬁed in
A total of eight topics were explored in previous research with older people on the
the focus groups to give a comprehen- characteristics of elderly-friendly com-
sive picture of the city’s age-friendliness. munities (14,15). The same basic questions
The topics cover the features of the city’s

PAGE 8


about each area were asked in the focus social environment and to the economic
groups in all cities. determinants of active ageing. The last two
topic areas, communication and informa-
The first three topics were outdoor spaces
tion and community support and health
and buildings, transportation, and housing.
services, involve both social environments
As key features of a city’s physical envi-
and health and social service determinants.
ronment, they have a strong influence on
The cross-cutting active ageing determi-
personal mobility, safety from injury, secu-
nants of culture and gender were included
rity from crime, health behaviour and social
only indirectly in this project, because
participation. Another three topics reflect
their influence on active ageing extends far
different aspects of the social environment
beyond urban living. Owing to their over-
and of culture that affect participation and
riding influence, these determinants merit
mental wellbeing. Respect and social inclu-
specially focused initiatives.
sion deals with the attitudes, behaviour and
messages of other people and of the commu- As with the determinants of active age-
nity as a whole towards older people. Social ing, these eight aspects of city life overlap
participation refers to the engagement of and interact. Respect and social inclusion
older people in recreation, socialization, and are reflected in the accessibility of the
cultural, educational and spiritual activities. buildings and spaces and in the range of
Civic participation and employment ad- opportunities that the city offers to older
dresses opportunities for citizenship, unpaid people for social participation, entertain-
work and paid work; it is related to both the ment or employment. Social participation,
in turn, influences social inclusion, as well

Figure 6. Age-friendly city topic areas
Tra

g
nsp

usin
ort

Ho
atio

Out tion
n

d
and oor sp cipa
buil aces lparti
ding
s S ocia
Age-
friendly
rt city R
su ppo
es soc espect
nity rvic ial i
mu alth se ncluand
Civ d em

sion
Com he
rma n

an
tion
info icatio

and
ic p plo
arti yme
and mun

cip nt
Com

atio
n

PAGE 9

as access to information. Housing aﬀects aspects of the city, the barriers and gaps,
needs for community support services, and the suggestions for improvement
while social, civic and economic participa- voiced by focus group participants in all
tion partly depend on the accessibility and cities were transcribed and grouped into
safety of outdoor spaces and public build- themes. The themes that were mentioned
ings. Transportation and communication in each city were recorded to form a picture
and information particularly interact with of what was most important overall and in
the other areas: without transportation or diﬀerent regions and cities. Based on the
adequate means of obtaining information to themes, a checklist of the core features of
allow people to meet and connect, other ur- an age-friendly city was developed in each
ban facilities and services that could support area of city living. The checklist is a faith-
active ageing are simply inaccessible. Fig. 6 ful summary of the views expressed by the
depicts the age-friendly city topic areas. focus group participants worldwide.

Identifying age-friendly features
For each topic, the reports of age-friendly

PAGE 10


Part 4. How to use the Guide

Core age-friendly features Who will use the Guide?
The purpose of this Guide is to help cit- The Guide is intended to be used by indi-
ies see themselves from the perspective of viduals and groups interested in making
older people, in order to identify where and their city more age-friendly, including gov-
how they can become more age-friendly. ernments, voluntary organizations, the pri-
The following parts of the Guide describe, vate sector and citizens’ groups. The same
for every area of city life, the advantages principle followed in creating the Guide ap-
and barriers that older people experience plies to using it; that is: involve older people
in cities at different stages of development. as full partners at all stages. In assessing
The checklist of core age-friendly features the city’s strengths and gaps, older people
concluding each part applies to less devel- will describe how the checklist of features
oped as well as more developed cities. It is matches their own experiences. They will
intended to provide a universal standard for provide suggestions for change and they
an age-friendly city. may participate in implementing improve-
ment projects. The situation of older people
The age-friendly features checklist is not a
articulated through this bottom-up ap-
system for ranking one city’s age-friendli-
proach provides the essential information
ness against another’s; rather, it is a tool for
to be distilled and analysed by gerontology
a city’s self-assessment and a map to chart
experts and decision-makers in developing
progress. No city is too far behind to make
or adapting interventions and policies. In
some significant improvements based on
the follow-up stages of “age-friendly” local
the checklist. Going beyond the checklist
action, it is imperative that older people
is possible, and indeed some cities already
continue to be involved in monitoring the
have features that exceed the core. These
city’s progress and acting as age-friendly
good practices provide ideas that other cities
city advocates and advisers.
can adapt and adopt. Nevertheless, no city
provides a “gold standard” in every area.

The checklists of age-friendly urban fea-
tures are neither technical guidelines nor
design specifications. Other technical doc-
umentation is available to help implement
changes that may be required in individual
cities (16,17).

PAGE 11

Part 5. Outdoor spaces and buildings

Overview of findings
You get out of your bed at four o’clock in the
The outside environment and public build- morning instead of six o’clock because there
ings have a major impact on the mobility, is too much noise outside.
independence and quality of life of older
Older person, Istanbul
people and affect their ability to “age in
place”. In the WHO project consultation,
In Tripoli, the smell of smoke from nar-
older people and others who interact sig-
guileh (oriental water pipes) is said to be
nificantly with them describe a broad range
“suffocating”, especially in the evenings and
of characteristics of the urban landscape
during Ramadan. In Jamaica, concern is
and built environment that contribute to
expressed at the loudness of music, com-
age-friendliness. The recurring themes in
pounded by the explicit language used in
cities around the world are quality of life,
the songs. In a number of cities, the per-
access and safety. Improvements that have
ceived dirtiness of the city detracts from
been made or that are under way in cities at
older residents’ quality of life. To address
all stages of development are welcomed by
these problems, people in Mexico City
those consulted, who also point out other
suggest that a “clean street” campaign be
changes that ought to be made.
organized, while in Jamaica, regulations ad-
1. Pleasant and clean environment dressing noise levels are recommended.

The beauty of the city’s natural surround- The size of the city is thought to be a prob-
ings is a feature that people in many cities lem in some cities. The increasing numbers
mention spontaneously as an age-friendly of people in Tokyo are thought to be linked
feature. For example, in Rio de Janeiro and to a reduction in community cohesiveness.
Cancún, living close to the ocean is seen Nairobi is considered to be overcrowded
as a definite advantage, as is living close to and difficult for older people to get around.
the river in Melville and London. In Himeji,
older people value the quiet and peaceful-
ness of their environment. At the same
time, older people do express complaints
with respect to their city’s cleanliness and
to disturbing noise levels and odours.

PAGE 12


2. Importance of green spaces 3. Somewhere to rest
Having green spaces is one the most com- The availability of seating areas is gener-
monly mentioned age-friendly features. ally viewed as a necessary urban feature for
However, in many cities there are barriers older people: it is difficult for many older
that prevent older people from using green people to walk around their local area with-
spaces. In New Delhi, for example, some out somewhere to rest.
green spaces are said to be poorly main-
tained and have become “dumps”, and in There are very few seating areas … you get
Himeji, some parks are considered to be tired and need to sit down.
unsafe. Concern is expressed in Melville
Older person, Melville
about the inadequate toilet facilities and
lack of seating. In Moscow it is reported
Older people and caregivers in Shanghai
that there is no protection from the weath-
appreciate the relaxing rest areas in their
er, while in Udaipur difficulties in getting
city. In Melbourne, the redevelopment of
to the parks are highlighted. Another issue
outdoor seating areas is viewed positively.
of concern is hazards resulting from shared
Yet there is some concern about encroach-
use of the park.
ment into public seating areas by people or
groups who are intimidating or who dis-
It may be a limiting factor to an older person
play antisocial behaviour. In Tuymazy, for
going into a park that might be a shared
activity area with bikes whizzing by, or example, it was requested that the public
skateboards or roller-bladers, or large bound- seating be removed for this very reason.
ing four-legged beasts.
4. Age-friendly pavements
Service provider, Melbourne
The condition of pavements has an obvious
impact on the ability to walk in the local
Different suggestions are offered to resolve
area. Pavements that are narrow, uneven,
these problems. Caregivers in Halifax see
cracked, have high curbs, are congested or
a need for small, quieter, contained green
have obstructions present potential hazards
spaces in the fringe areas of the city rather
and affect the ability of older people to walk
than the large busy parks used by children
around.
and skateboarders. Older people in Amman
recommend special gardens for their age
I had a fall due to the pavement. I broke my
group, while older people in New Delhi
shoulder.
suggest demarcated areas in parks for older
people. Better park maintenance is called Older person, Dundalk
for in several locations.
Inadequate pavements are reported as an
almost universal problem. In many cities,
such as Mexico City, Rio de Janeiro and
those in Jamaica, pedestrians are forced to

PAGE 13

share the pavements with street vendors. 5. Safe pedestrian crossings
In other cities, such as La Plata, Moscow,
The ability to cross the road safely is an
Ponce and the Ruhr metropolitan region,
often mentioned concern, and it is reported
cars parked on the pavement force pedes-
that several cities have taken steps to im-
trians to walk on the road. The weather
prove the conditions for people crossing the
may compound the difficulties experi-
road: traffic lights at pedestrian crossings in
enced by older people using pavements. In
Cancún; traffic islands in La Plata; pedes-
Sherbrooke, for example, concern is ex-
trian crossings in Mayaguez, and non-slip
pressed about snow not being cleared from
strips on pedestrian crossings in Portland.
the pavements and in Portage la Prairie, the
Amman has built bridges and tunnels to
risk of falls is considered greater after it has
assist pedestrians to cross roads.
snowed.
In quite a few cities, it is reported that
Approval is expressed for improvements
the pedestrian crossing lights change too
that some cities are making to the design
quickly. In Melville, it is suggested that the
and maintenance of pavements. The follow-
crossing lights have a visual “countdown” so
ing features to make pavements age-friend-
that pedestrians know how much time they
ly are often suggested:
have to cross the road. The auditory signals
• a smooth, level, non-slip surface; at pedestrian crossings are much appreciat-
ed in Istanbul, and in Portland and Udine,
• sufficient width to accommodate wheel-
auditory as well as visual cues at crossings
chairs;
are recommended.
• dropped curbs that taper off to be level
with the road; Cross lights are made for Olympic runners.
• clearance from obstructions such as Older person, Halifax
street vendors, parked cars and trees; and
• priority of access for pedestrians. Another common concern is that drivers
fail to follow traffic signals and do not give
I don’t live downtown, I live in La Loma, but way to pedestrians.
we have the same problem with the side-
walks and stuff. It is hard for me to walk,
… there are pedestrian crossings but motor-
I use a cane, and I’m all the time looking
ists have no respect for pedestrians. They
down, as a friend of mine used to say. Now
see you on the thing and they come right up
when I’m walking round downtown and ask
on you. If your heart is not strong you drop
for help to go across 7th street, I always see if
down.
I can find a young person or so, and people
come to me, so I can’t complain about that, Older person, Jamaica
about people helping.

Older person, La Plata

PAGE 14


In most of the cities, the volume and speed 7. A secure environment
of road traffic is said to present barriers for
Feeling secure in one’s living environment
older people, both as pedestrians and as
strongly affects people’s willingness to
drivers. In Udaipur, it is reported that the
move about in the local community, which
traffic is chaotic and older people fear going
in turn affects their independence, physi-
out because of heavy traffic; some will not
cal health, social integration and emotional
go out unless they are accompanied. (The
well-being. Many cities are considered to
difficulties encountered by older drivers are
be generally safe from harm by others, but
discussed in Part 7.)
others clearly are not. Regardless of the ac-
6. Accessibility tual level of danger, concerns about security
are expressed nearly everywhere, including
In both developed and developing coun-
matters such as street lighting, violence,
tries, people think that their city was not
crime, drugs and homelessness in public
designed for older people.
places. Going out at night is especially fear-
ful for many older people.
I only go into town when I have something
specific to do. I go there and finish what I am
We are not going out in the evenings. I don’t
doing and come straight back home. Why
go anywhere … they might kill you.
would I want to walk around the city? I am
not a young person. Older person, Tuymazy
Older person, Nairobi
It is acknowledged that some cities have
In many cities, reference is made to barri- taken measures to improve security; for
ers to physical access, which can discour- example, it is pointed out that Geneva and
age older people from leaving their homes. Sherbrooke have installed surveillance
In Rio de Janeiro, it is pointed out that the cameras.
concrete ladders to access the favela (shanty
A suggestion made in La Plata to improve
town) are difficult for older people to use.
security is to involve the community, such
The lack of ramps in some areas is an issue
as promoting self-organized groups among
in Sherbrooke. The common recommenda-
older people for greater outdoor safety as
tion for addressing these concerns is educa-
well as providing more police. In Dundalk,
tion, particularly for urban planners and
it is suggested that the government provide
architects, about the needs of older people.
a grant to enable older people to improve
their personal security.

Earthquakes occur frequently in Turkey,
and older people in Istanbul are concerned
that the city is not designed to minimize
the risk of injury resulting from earth-
quakes.

PAGE 15

9. Age-friendly buildings
We should have an empty space to feel safe
In many cities, including Himeji, Mayaguez,
from the earthquakes, but they don’t give us,
they tell us to use the streets. Melbourne and New Delhi, reference is
made to new buildings being accessible and
Older person, Istanbul improvements being made to make build-
ings more accessible. Generally, the features
8. Walkways and cycle paths that are considered necessary for buildings
Walkways and cycle paths are seen as to be age-friendly are:
part of a health promoting, age-friendly • elevators
environment, yet there are hazards noted
as well. In Geneva, cyclists are thought • escalators
by some to be a danger to older people. • ramps
In Udine, it is suggested there should be
• wide doorways and passages
two pathways – one for cyclists and one
for pedestrians. Older people in Cancún, • suitable stairs (not too high or steep) with
Portland and Saanich value the walking railings
trails provided in their cities. The need to • non-slip ﬂooring
ensure walkways have a smooth surface is
• rest areas with comfortable seating
highlighted by caregivers in Halifax, and
the need to ensure they are easy to access • adequate signage
with suﬃcient wheelchair access points is • public toilets with handicap access.
mentioned by older people and caregivers
in Portage la Prairie. Older people in Udine In two cities, however, barriers to older
advise developing a system of walkways people using elevators are mentioned. In
to move through the area, and in Halifax, Nairobi, older people have a fear of using el-
walkways in car parks are called for to evators and need to be accompanied; while
ensure the safety of pedestrians. Adding in Tripoli, older people are reluctant to use
public toilets near walkways is another idea elevators as electricity failures are common
put forward in Saanich. and they fear being stranded.

While there is widespread recognition of
the importance of having accessible build-
ings, it is also widely acknowledged that
many buildings, particularly old buildings,
are not accessible. In some cases, it is not
possible to make old buildings more ac-
cessible. Most of the cities see a need to
improve the accessibility of their buildings,
particularly to facilitate wheelchair access.

Some positive and negative attributes of

PAGE 16


large shopping centres are also mentioned. 11. Older customers
In Dundalk and Melville, some shop-
Good customer service that appreciates the
ping centres provide wheelchairs for their
needs of older people is considered to be an
customers and have wheelchair access. In
age-friendly feature. Preferential treatment
Melbourne, the need to walk long distances
is given to older people in Cancún, and in
is seen as a barrier to using large shopping
Jamaica, some businesses provide wheel-
centres. In Istanbul, shopping centres have
chairs for older customers. In Mexico City,
escalators but older people find them dif-
priority service is provided to older people
ficult to use.
by law. In Portland, an “elderly-friendly”
It is considered that buildings, including business guide and audit system has been
shops, should be located close to where developed by a voluntary group.
older people live to enable them to have
One of the barriers identified in a number
easy access to these services and facilities.
of cities is the long queues or waiting times
Older people in Tuymazy appreciate living
older people face to be served. It is sug-
close to stores and markets. The clustering
gested that special service arrangements
of businesses in Sherbrooke allows older
be made for older people, such as separate
people to do their transactions within a
queues or service counters. Older people in
small radius of their homes.
Islamabad recommend giving older women
10. Adequate public toilets priority in queues. In Sherbrooke, it is sug-
gested that seats be placed in businesses,
The availability of clean, conveniently locat-
such as banks, where older people are
ed, well-signed, handicap-accessible toilets
required to wait.
is generally regarded as an important age-
friendly feature of the built environment. In Another barrier identified in some cities,
Islamabad, appreciation is expressed for the including London and Tokyo, is the disap-
recently introduced public toilets, which pearance of the local shop or convenience
are increasing in number. store. With their closing, older people lose
a potential source of social contact and are
A number of barriers are identified in rela-
required to travel further to shop.
tion to public toilets. In Halifax, it is noted
that the toilet doors are heavy. In Himeji,
public toilets are small and not all are the
type with seats. In La Plata, caregivers point
out that there are no toilets accessible to
people with disabilities.

PAGE 17

Age-friendly outdoor spaces and buildings
checklist
Environment Pavements
• The city is clean, with enforced regula- • Pavements are well-maintained, smooth,
tions limiting noise levels and unpleasant level, non-slip and wide enough to ac-
or harmful odours in public places. commodate wheelchairs with low curbs
that taper off to the road.
Green spaces and walkways
• Pavements are clear of any obstructions
• There are well-maintained and safe green
(e.g. street vendors, parked cars, trees,
spaces, with adequate shelter, toilet
dog droppings, snow) and pedestrians
facilities and seating that can be easily
have priority of use.
accessed.
Roads
• Pedestrian-friendly walkways are free
from obstructions, have a smooth sur- • Roads have adequate non-slip, regularly
face, have public toilets and can be easily spaced pedestrian crossings ensuring that
accessed. it is safe for pedestrians to cross the road.

Outdoor seating • Roads have well-designed and appropri-
ately placed physical structures, such as
• Outdoor seating is available, particularly
traffic islands, overpasses or underpasses,
in parks, transport stops and public spac-
to assist pedestrians to cross busy roads.
es, and spaced at regular intervals; the
seating is well-maintained and patrolled • Pedestrian crossing lights allow sufficient
to ensure safe access by all. time for older people to cross the road
and have visual and audio signals.

PAGE 18


Traffic Buildings
• There is strict enforcement of traffic rules • Buildings are accessible and have the fol-
and regulations, with drivers giving way lowing features:
to pedestrians.
– elevators
Cycle paths – ramps
• There are separate cycle paths for cyclists. – adequate signage
Safety – railings on stairs
• Public safety in all open spaces and – stairs that are not too high or steep
buildings is a priority and is promoted
– non-slip flooring
by, for example, measures to reduce the
risk from natural disasters, good street – rest areas with comfortable chairs
lighting, police patrols, enforcement of – sufficient numbers of public toilets.
by-laws, and support for community and
personal safety initiatives. Public toilets
• Public toilets are clean, well-maintained,
Services
easily accessible for people with varying
• Services are clustered, located in close abilities, well-signed and placed in conve-
proximity to where older people live and nient locations.
can be easily accessed (e.g. are located on
the ground floor of buildings).
• There are special customer service ar-
rangements for older people, such as
separate queues or service counters for
older people.

PAGE 19

Part 6. Transportation

Overview of findings disabled or frail older people, taxis, and
personal drivers. Yet in cities at all stages of
Transportation, including accessible and
development, there are gaps reported that
affordable public transport, is a key factor
need to be addressed to make the commu-
influencing active ageing. It is a theme run-
nity more age-friendly.
ning through many other areas of discus-
sion. In particular, being able to move 2. Affordability
about the city determines social and civic
Cost is viewed as a significant factor affect-
participation and access to community and
ing older people’s use of public transport.
health services.
In some cities, free or subsidized public
People consulted in the WHO project transport for older people is said to be pro-
therefore have a lot to say on the topic, cov- vided. Geneva reportedly offers free trans-
ering every aspect of infrastructure, equip- port for someone accompanying an older
ment and service for all means of urban person, and in Dundalk, people 75 years
transportation. and older are entitled to a Companion Pass.
In some cities, however, the cost of public
For many older people, their lives are guided transport is considered to be too expensive.
by the available transport system. Older people in Nairobi complain about the
Service provider, Dundalk arbitrary price increases charged because of
bad weather, public holidays and peak travel
periods. Difficulties getting subsidized or
1. Availability
free fares are mentioned. In Himeji, it is
Public transport services are said to be said that the eligibility age for the com-
available in almost all of the cities, although plimentary pass is too high, while in New
not in all areas. Cities in developed coun- Delhi, the application process for conces-
tries and those with a transition economy sion travel is considered to be cumbersome.
(e.g. the Russian Federation) are more In Rio de Janeiro, free transport is not
likely to indicate that their public transport provided to the older people who live in the
system is well-developed or satisfactory. A favela, as public transport does not service
range of transport services are available in this area. In Geneva, discounted travel can
many cities, including buses (private and only be obtained if older people purchase a
public), trains, trams, trolleybuses, rick- railway season ticket. Subsidized fares can-
shaws (private and public), shuttle buses
and minibuses, community (voluntary)
transport services, services specifically for

PAGE 20


not be used for private transport services In a few cities, such as Geneva, London,
in some cities, although in Dundalk, free Moscow and Tokyo, people indicate that
travel passes are accepted on some private their public transport services are reli-
bus services. able but this is not always the case in other
similarly developed cities. This was not an
People in some cities suggest that free
age-friendly feature reported in develop-
transport or subsidized transport be
ing cities. In Amman, there is no fi xed
provided or extended for older people. In
timetable for the buses, and in Islamabad,
Mexico City, it is suggested that free trans-
there is no fi xed timetable for public service
port be provided for older people to attend
vehicles. In La Plata, the buses are unreli-
specific events.
able as the routes are often changed.
3. Reliability and frequency 4. Travel destinations
Having frequent and reliable public trans-
The ability to use public transport depends
port services is identified as an age-friendly
very much on being able to get to where
feature. Some older people, especially in de-
you want to go. People in quite a few cities
veloped countries, indicate that the frequen-
state that their public transport services
cy of their city transport services is good.
provide good coverage of at least some ar-
Nevertheless, there are a number of reports eas, enabling people to get to their desired
from cities at varying stages of develop- destination. But concern is expressed in
ment that public transport services are not other cities in both developed and develop-
frequent or reliable enough. In Istanbul, ing countries about the adequacy of public
older people indicate that travelling by transport routes; people complain that sev-
public transport takes a very long time eral areas of the city are not covered, or it is
as it is not frequent. In Melbourne, some difficult to cross the entire city, or there are
areas are said to have no bus service from poor connections between buses and other
Saturday afternoon until Monday morning. means of transport. In addition, important
In the Ruhr metropolitan area, older people destinations of older people are not well-
consider that public transport to the outer served. For instance, the bus in Dundalk
areas of the city and at night is not frequent does not travel to one of the nursing homes,
enough. In some cities, it is suggested that and in Mayaguez, there is limited transpor-
public transport be more frequent, particu- tation to the seniors’ centres. In Tuymazy,
larly at night and at weekends. access by public transport to public gardens
is considered insufficient.

PAGE 21

6. Specialized services for older
The thing with public transit, there are big
people
holes ... if you want to go downtown you’re
in great shape, if you want to go across town Older people who have difficulties using
you’re going to have to struggle. public transport need to have specially
Older person, Portland adapted means of transport. These are
mentioned as an age-friendly feature in
some cities in developed countries, but in
5. Age-friendly vehicles
others there are few such options available.
Boarding and disembarking from vehicles is Recommendations are made to provide
another major issue raised. A number of cit- services for people with disabilities. For
ies are reported to have some public trans- example, in Rio de Janeiro, caregivers men-
port vehicles that are modified to provide tion that taxis are the only available means
easier access for older people: in Shanghai, of transport for older people with disabili-
modified seating is provided; in Saanich, ties, but that their wheelchairs cannot fit
there are some accessible buses; and in into the boot of the vehicle because the
Udaipur, a public bus service is starting soon petrol tank is located there. In Mexico City,
with low-floor buses. In Geneva, some buses caregivers suggest the provision of adapted
have raised platforms and low floors. buses specifically for disabled people and
their caregivers.
People commonly observe that the design
of public transport vehicles presents barri- 7. Priority seating and passenger
ers to older people. In Udine, for example, courtesy
the older people say that it is difficult to use
A few cities indicate that having priority
buses owing to the high steps on the buses,
seating on public transport for older people
and in Ponce, buses are not adapted for
is an age-friendly feature and in some cities,
wheelchair access.
such as Islamabad, passengers do respect
Residents in a small number of cities also the priority seating for older people. This
mention other features that discourage courtesy is not common, however, and pub-
the use of public transport. In New Delhi, lic education on courtesy in public trans-
older people point out that the bus route portation is recommended by, for example,
numbers are not clearly displayed on public older people in Moscow.
service buses. The service providers in
Dundalk question the roadworthiness of 8. Transport drivers
some buses, and in La Plata, older people In some cities, courteous transport driv-
express concern about the deteriorated ers are described as an age-friendly feature
condition of some buses. facilitating the use of public transport. In
many others, however, concern is expressed
about the insensitivity of drivers, particu-
larly bus drivers, towards older people.

PAGE 22


One of the major concerns raised is that A final issue identified in a few develop-
drivers do not wait for older people to be ing cities is exploitation by drivers. For
seated before starting off. example, in New Delhi, some rickshaw
drivers overcharge their passengers, and in
I can get on the bus but the minute the man Nairobi, fares are changed very arbitrarily.
takes off the bus rocks and I’m flat on my
face. Not surprisingly, in quite a few cities it is
suggested that drivers should be educated
Older person, Saanich
to be sensitive to the needs of older people.
The driver training programme that has
In Rio de Janeiro, it is pointed out that been implemented in Sherbrooke is regard-
many middle class older people take a taxi ed as a benefit for older passengers.
or the metro rather than ride in a bus, be-
cause they are afraid of falling in a bus. In a small number of cities, it is suggested
other transport staff, for example counter
A particular problem identified in devel- staff, should also be educated about the
oping cities, such as Amman, is drivers’ needs of older people and how this affects
reluctance to pick up older people. In Delhi their use of transport services.
and Geneva, older people highlight the
difficulties caused when bus drivers do not 9. Safety and comfort
stop close enough to the curb to enable
Whether or not people feel safe using pub-
them to get on and off the bus safely. People
lic transport has a significant effect on their
in Dundalk mention that bus drivers stop at
willingness to use these services. In a few
unmarked locations, which is often danger-
cities, it is reported that public transport is
ous, particularly at road corners. In Geneva
safe. In Cancún it was mentioned that there
and Ponce, some bus drivers are said to be
is less crime on public transport services
to be impolite.
than in other cities, and in Melbourne and
Other identified barriers include careless driv- Moscow, public transport is deemed to be
ing and disregard for the rules of the road. safe. Yet even in places where some people
consider public transport safe to use, for
They drive like mad … with very loud music. example London, it is still suggested that
steps be taken to further improve safety. In
Older person, Mexico City the many cities where reservations about
the safety of public transport are expressed,
the issues are theft or antisocial behaviour.

PAGE 23

10. Transport stops and stations
The main problem is getting on and off the
buses. Which of your pockets are you going The design, location and condition of
to control? While you are looking after your transport stops and stations are significant
pocket, you see that your purse has gone. features as well. In Shanghai, older people
Older person, Istanbul. and caregivers value the benches, shelter
and lighting provided at some transport
In many cities, crowded public transport, stops. In Ponce, the bus stops and terminal
particularly during peak times (the “rush are kept in good condition. In Portland,
hour”), also presents safety issues for older convenient access to transport stops is
people. This problem is more commonly viewed with satisfaction.
identified in developing cities and in the The location of transport stops presents
Russian cities. For example, in Jamaica, some difficulties for older people. Problems
pushing and shoving is reported to be a are encountered in Melbourne when there
problem for older people at bus stops and are few bus stops and the distance between
on boarding buses. In Moscow, it is pointed the stops is too great. In Melville, older
out that crowding makes it difficult to people express concern about having to
breathe in the railway station. cross a major road to get to the bus stop. In
A few developed cities, like Dundalk, Saanich, some older people mention that
Portland and Saanich, also mention dif- bus stops are too far from their homes.
ficulties related to overcrowded public In some cities, there are issues of safety at
transport. transport stops. In Moscow, it is reported
that there are pickpockets in the crowds
You can’t breathe on it [train from Dublin]. If at the transport stops, and in Melbourne,
you collapsed nobody would know – you’re
there are complaints about vandalism at
wedged up!
bus stops. In Melville, a programme by
Older person, Dundalk which children decorate bus stops is be-
lieved to have reduced vandalism.
In Nairobi, older people note with satis-
In San José, the lack of shelter at transport
faction that overcrowding problems have
stops is perceived as a disadvantage, as is
significantly improved since the introduc-
the lack of seating at transport stops in
tion of legislation, the Michuki Rules, to
Shanghai. In Tokyo, however, it is pointed
ensure the required seating capacity is not
out that placing benches at bus stops makes
exceeded. In Tuymazy, providing more
it difficult for people with disabilities to
buses during peak times is suggested, while
walk around them, because the streets are
in Saanich, it is recommended that older
very narrow.
people be encouraged to use public trans-
port outside peak times.

PAGE 24


People in many cities consider that railway 12. Community transport
stations and bus terminals should be easy
The availability of community transport
to get to and should have an age-friendly
services (i.e. free transportation pro-
design with ramps, escalators, elevators,
vided by the voluntary or private sector)
public toilets and clearly visible signage. In
is considered to be an age-friendly service
Tokyo, older people and caregivers value
more often mentioned by people in devel-
the lift that was installed in the metro
oped than in developing cities. In Ponce,
station. In the Ruhr metropolitan region,
for example, there is free transportation
older people consider the lack of facilities
provided by seniors’ centres to attend medi-
as the main railway station to be a barrier
cal appointments, and in Portage la Prairie
to transporting luggage and wheelchairs
community volunteer drivers and the
up to the platforms. In New Delhi, older
shuttle service provided by grocery stores
people point out that the metro station is
are valued services. In London, a suggested
not located close to where they live and that
service is community transport with fully
signage at the station is inadequate.
accessible buses and drivers trained to
11. Taxis serve older people.

Taxi services are viewed as an age-friendly 13. Information
transportation option in a number of cit-
In a few cities, there is mention of the
ies. In Cancún, taxis are considered to be
importance of having information on
affordable. In Dundalk, older people value
transport options, on how to use transport
the discounted fares provided by taxi
services, and on timetables. In Portland, for
services. In Melville, caregivers appreciate
example, programmes are provided to teach
the government subsidy scheme for the use
older people how to use public transport.
of taxis. In Halifax, it is said that some taxi
In Melville, it is suggested that older people
drivers are very helpful to older people, and
who can no longer drive be offered a course
in Tripoli, it is reported that taxis provide a
on how to use public transport. In Himeji,
good and convenient service.
it is suggested that bus timetables indicate
In other cities, barriers are identified in the whether the bus is one that is accessible to
use of taxis. Cost is one barrier and lack of people with disabilities. Older people in
disability access is another. In Portage la Tokyo identify the need for timetables to be
Prairie, caregivers are concerned that taxi in larger print and conveniently located.
drivers will not take wheelchair customers.
In Halifax, the design of the taxi is a prob-
lem because there is no room to transport a
walking frame. In Tuymazy, it is suggested
that taxis should have large boots to ac-
commodate wheelchairs.

PAGE 25

14. Driving conditions traffic rules and regulations. For example,
in Rio de Janeiro, the heavy traffic is viewed
Driving as an essential transportation op-
as a barrier. In Cancún the older people
tion for older people is discussed in a few
complain that the roads have holes and are
locations. For example, it is observed that
generally in a bad condition. In Melville,
Melville is a city designed for cars, and in
concerns are raised about ineffective traf-
Himeji, cars are considered a necessity in
fic calming devices such as roundabouts,
the suburbs. In Ponce, cars are viewed as
which are either too small or are placed in
necessary because of the limited transport
inappropriate places. In Mayaguez, older
options available.
people report that streets are not well-lit. In
People in a few cities indicate that it is easy Halifax, the street signage is considered too
to drive around the city, a feature more small, too high and often obscured. Older
likely to be mentioned by those in devel- people in Udine report that drivers do not
oped countries. In Portage la Prairie, the respect traffic regulations. In Sherbrooke,
traffic is said to be light and driving easy. other drivers are said to be often aggressive.
In Saanich, the older people appreciate the
advance warnings of crossroads. In Tokyo,
15. Courtesy towards older drivers
older people mention that the road signals In addition to the barriers identified above,
and signs are easy to see. The streets of the disrespect shown to older drivers dis-
Tripoli are considered to be well-marked, courages a number of them.
and in Shanghai, the traffic management is
viewed as good. I dislike driving. People curse you, make signs
at you if you go slow. They are impolite.
People in many more cities in countries at
all stages of development report barriers Older person, Tripoli
to city driving. These include heavy traffic,
poor condition of roads, ineffective traffic In La Plata, it is stated that older drivers
calming devices, inadequate street light- are abused because they drive too slowly.
ing, inadequate signage that is obscured In Cancún, older people feel unsafe when
or poorly positioned, and the disregard for driving owing to their own vision problems
and the aggressive traffic. In Tuymazy, ser-
vice providers comment that older people
are not confident driving on the roads.

PAGE 26


In many cities, however, inadequate and
In some cities, such as Portage la Prairie,
costly parking facilities are identified as
where driving is an essential transport op-
barriers for older people. Other problems
tion, concerns are raised about the difficul-
are mentioned too. In Mayaguez, it is said
ties that older people face when giving up
that there are not enough drop-off and
their licences. To ensure older people are
pick-up points for older people with dis-
confident drivers, refresher courses are rec-
abilities, while in Portage la Prairie, it is
ommended in some cities such as including
pointed out that the parking bays are not
Geneva and Portland. The special lessons
wide enough for loading wheelchairs. In
given to older people in Himeji when they
Saanich, the lack of handicap parking bays
need to renew their licence is viewed as an
is raised as an issue. In Melbourne, con-
age-friendly advantage.
cern is expressed about the inability to
16. Parking find parking close to buildings. One other
concern expressed is the lack of respect for
Priority parking bays for older and handi- priority handicap parking bays.
capped people in close proximity to build-
ings, together with drop-off and pick-up They make disabled bays that are totally and
bays, were seen as age-friendly features. utterly ignored.
In Amman, older people value the bays
Older person, London
for the handicapped provided by stores. In
Dundalk, free parking is appreciated. In
Portage la Prairie, the large car park is con-
sidered an age-friendly asset for drivers.

PAGE 27

Age-friendly transportation checklist

Affordability Specialized services
• Public transportation is affordable to all • Sufficient specialized transport services
older people. are available for people with disabilities.
• Consistent and well-displayed transpor- Priority seating
tation rates are charged.
• Priority seating for older people is provid-
Reliability and frequency ed, and is respected by other passengers.
• Public transport is reliable and frequent Transport drivers
(including services at night and at week-
• Drivers are courteous, obey traffic rules,
ends).
stop at designated transport stops, wait
Travel destinations for passengers to be seated before driving
off, and park alongside the curb so that
• Public transport is available for older
it is easier for older people to step off the
people to reach key destinations such as
vehicle.
hospitals, health centres, public parks,
shopping centres, banks and seniors’ Safety and comfort
centres.
• Public transport is safe from crime and is
• All areas are well-serviced with adequate, not overcrowded.
well-connected transport routes within
the city (including the outer areas) and Transport stops and stations
between neighbouring cities. • Designated transport stops are located
• Transport routes are well-connected in close proximity to where older people
between the various transport options. live, are provided with seating and with
shelter from the weather, are clean and
Age-friendly vehicles safe, and are adequately lit.
• Vehicles are accessible, with floors that • Stations are accessible, with ramps, esca-
lower, low steps, and wide and high seats. lators, elevators, appropriate platforms,
• Vehicles are clean and well-maintained. public toilets, and legible and well-placed
signage.
• Vehicles have clear signage indicating the
vehicle number and destination. • Transport stops and stations are easy to
access and are located conveniently.
• Station staff are courteous and helpful.

PAGE 28


Information • Roads are free of obstructions that might
block a driver’s vision.
• Information is provided to older people
on how to use public transport and about • The rules of the road are strictly enforced
the range of transport options available. and drivers are educated to follow the
rules.
• Timetables are legible and easy to access.
• Timetables clearly indicate the routes of
Driving competence
buses accessible to disabled people. • Refresher driving courses are provided
and promoted.
Community transport
• Community transport services, including
Parking
volunteer drivers and shuttle services, are • Affordable parking is available.
available to take older people to specific
• Priority parking bays are provided for
events and places.
older people close to buildings and trans-
Taxis port stops.

• Taxis are affordable, with discounts or • Priority parking bays for disabled people
subsidized taxi fares provided for older are provided close to buildings and trans-
people with low incomes. port stops, the use of which are moni-
tored.
• Taxis are comfortable and accessible,
with room for wheelchairs and/or walk- • Drop-off and pick-up bays close to build-
ing frames. ings and transport stops are provided for
handicapped and older people.
• Taxi drivers are courteous and helpful.

Roads
• Roads are well-maintained, wide and
well-lit, have appropriately designed and
placed traffic calming devices, have traffic
signals and lights at intersections, have
intersections that are clearly marked,
have covered drains, and have consistent,
clearly visible and well-placed signage.
• The traffic flow is well-regulated.

PAGE 29

Part 7. Housing

Overview of findings For example, in Geneva it is reported that
some older people are living in houses that
Housing is essential to safety and well-be-
are too big for them but, because they are
ing. Not surprisingly, people consulted
pensioners, they cannot afford to move.
by WHO in all regions have much to say
Similarly, in Tuymazy, it is stated that the
on different aspects of housing structure,
cost of moving house is too expensive and
design, location and choice. There is a link
not possible for retirees. Free or low-cost
between appropriate housing and access to
public housing is regarded as a definite age-
community and social services in influenc-
friendly advantage in some cities, such as
ing the independence and quality of life of
London. In other cities, such as Islamabad,
older people. It is clear that housing and
the lack of low-income housing is seen as
support that allow older people to age com-
a barrier. The need to have information
fortably and safely within the community
about subsidized housing is highlighted in
to which they belong are universally valued.
Portage la Prairie.
1. Affordability
I’ve got a terraced house, council, rent-free.
There is general agreement among the cities I love it.
that the cost of housing is a major factor
influencing where older people live and their Older person, London
quality of life. While in some cities the cost
of housing, including rent, is considered to In cities in countries at all stages of devel-
be affordable, in others housing is regarded opment, it is recommended that affordable
as expensive, making it difficult for older housing be available for older person. Ideas
people to move to more appropriate housing. include a lower level of tax on housing for
older people in Amman, and having a hous-
I have my retirement salary but how can I ing subsidy for public and private housing
live with this little money? It comes into my in Himeji.
house and it goes away in a few seconds.


PAGE 30


2. Essential services has even surfaces; has an elevator if it is
multi-level accommodation; has appropri-
In a small number of cities, essential ser-
ate bathroom and kitchen facilities; is large
vices are found to be inadequate or very
enough to move about in; has adequate
expensive. In Islamabad, houses in low-
storage space; has passages and doorways
income areas have no electricity, gas or
large enough to accommodate a wheelchair;
water supply. In Moscow, the public utility
and is appropriately equipped to meet the
services are considered to be expensive.
ambient environmental conditions.
In Dundalk and Istanbul, older people are
concerned by the high costs of heating and Problems with housing construction are
think that the government should assist mentioned in a few cities. In Mexico City,
with heating costs. In Jamaica, older people people identify the need for supervised
on a low income find it difficult to pay the construction to ensure that the housing is
high utility costs and suggest that these structurally sound. Poverty is said to result
costs should be reduced. in poorly constructed or maintained hous-
ing in Istanbul, and in Nairobi, the lack of
When they send me the water bill it costs available construction materials is a source
me $1000. I can’t afford it so I don’t use the of concern. In Islamabad, some housing is
shower and sometimes there is no water.
not earthquake-proof.
Older person, Jamaica
A number of structural features are identi-
fied as barriers. Home layout that impedes
In Rio de Janeiro, older people value the im-
mobility is a problem identified in Dundalk.
provements that have been made in water,
In La Plata, stairs and uneven floors are ex-
sanitation and electricity services, and in
perienced as barriers. In Moscow, the need
Istanbul, the older people appreciate the
for purpose-built bathrooms and toilets for
good water supply.
older people is reported. In New Delhi, it is
3. Design considered that kitchens need to be better
designed. In Mexico City, the need to have
Several aspects of housing design are con- railings and elevators in multi-level build-
sidered to affect the ability of older people ings is mentioned, and people in Tokyo
to live comfortably at home. In general, it point out the need for passages and door-
is considered important for older people to ways to accommodate wheelchairs.
live in accommodation that is built from
adequate materials and structurally sound; In a small number of cities, housing is not
appropriately equipped for the weather
conditions. In particular, air-conditioning
is a reported need in Cancún and in some
areas of Melville, where the roof design of
new houses makes it hotter inside.

PAGE 31

In many cities, there is recognition of the A number of difficulties are identified in
measures that have been taken to improve relation to home modifications. In Halifax,
housing design to accommodate older retrofitting a home is considered to be ex-
people. In Mexico City, for example, 1% of pensive and difficult. Restrictions on the re-
all houses built must be suitable for older modelling of public housing are mentioned
people. In Halifax, some condominiums in Himeji and New Delhi. In Portland,
are age-friendly and have access ramps, rented accommodation that has been
elevators, parking, gym facilities and wide remodelled is required to be returned to its
doorways. original state. In Melbourne, it is pointed
out that assistance equipment is not used
Nevertheless, people frequently feel that
because it does not fit into the home and
more needs to be done to ensure housing
many caregivers are unable to afford the
is appropriate for older people. In Himeji,
necessary renovations. In Sherbrooke, the
more age-friendly housing is recom-
need to adapt housing for specific condi-
mended, while in Melbourne, incentives to
tions is mentioned.
encourage architects and property develop-
ers to build age-friendly housing are sug- Besides identifying the need to ensure older
gested. People in New Delhi recommend people are aware of the possible options
that age-friendly features be incorporated for modifying their homes, it is suggested
into building by-laws. In Saanich, builders in many cities that older people need to
include adapted or adaptable features into be able to obtain the necessary equip-
their plans, such as lower placement of light ment. In Tuymazy, caregivers identify their
switches, installation of showers rather need for information on different types of
than bathtubs, and stairways that can be equipment and possible adaptations and
converted to accommodate a chairlift. on equipment that is easy to obtain. In
Udaipur, difficulties in obtaining hand rails,
4. Modifications ramps and toilets are mentioned.
The ability to modify one’s house or
5. Maintenance
apartment also affects the ability of older
people to continue to live comfortably at Being unable to maintain one’s home is as
home. Caregivers in Dundalk appreciate a major barrier for some older people. In
the chairlifts that were installed to assist Cancún, older people say they are unable
older people. In Mayaguez, apartments for to make repairs owing to the cost involved.
disabled older people have the adaptations In Melbourne, they are likewise concerned
required. In a small number of cities, such about costs of maintenance and suggest
as Himeji and Dundalk, financial assistance that the local municipality provide a home
is provided for home modifications. maintenance service for a nominal fee. In
Rio de Janeiro, the high cost of condomin-
ium maintenance fees is considered to be a

PAGE 32


barrier, although it is pointed out that it is mentioned the importance of the concierge
possible to sublet condominiums to assist in establishing contact among residents and
with the cost of the maintenance fees. taking care of repairs.

In Dundalk, the older people value the 6. Access to services
grants provided for home repairs but com-
The provision of services to older people
plain about difficulties in organizing the
in their homes is particularly important.
service people to undertake the repairs.
In Udine, it is stated that older people do
not consider moving house. In Tuymazy,
Went away in the middle of it and didn’t
the service providers similarly indicate
come back for months to finish it.
that older people are very attached to
Older person, Dundalk their homes and do not want to move. In
Saanich, receiving home assistance is con-
In Melville, concern is raised about hav- sidered preferable to moving house.
ing strangers coming into the home to do
maintenance work, and it is suggested that In a few cities, difficulty in obtaining
the local municipality maintain a list of de- services at home, including their cost, is
pendable repair services that are prepared considered a disadvantage. In the Ruhr
to deal with older people. In Portland, metropolitan region, services such as clean-
caregivers appreciate the system used for ing and gardening are seen to be scarce and
screening contractors and other repair and expensive. Older people in Saanich report
maintenance services. that there are not enough cleaning and
gardening services available.
Problems are also identified regarding the
maintenance provided in public housing Living close to services and facilities is also
and rented accommodation. In London, seen as an age-friendly feature. This is more
concern is raised about repairs not being commonly mentioned by people in cities
done in a timely manner. In Tripoli, older in developed countries, such as Melville,
people indicate that landlords purposely Portage La Prairie and Tokyo. In San José,
neglect maintenance so that the older older people valued living in close proximity
people leave. In Delhi, it is reported that to public, commercial and religious ser-
common areas like staircases are often vices. In a number of cities, such as Nairobi,
neglected, dirty and dark. Udaipur and Udine, not living in close prox-
imity to such services is seen as a problem.
Nevertheless, staff in collective dwellings,
such as concierges and caretakers, some-
times play an important role in ensuring
well-being. In Geneva, the older people

PAGE 33

Nevertheless, caution is also expressed the lack of contact with younger people in
about remaining at home and being unable apartment buildings is seen as a disadvan-
to look after oneself adequately. In Mexico tage. In Udaipur, caregivers are concerned
City, the need to educate older people about that modern flats without front verandas
the risks of living at home is raised, and in leave no room for community interaction.
Saanich, the idea is advanced on provid- The importance of design that facilitates
ing information on home services for older community interaction is mentioned in
people by publishing a directory of home Dundalk as well, where it is suggested that
support services houses should overlook communal facilities
to reduce the sense of isolation.
7. Community and family
connections 8. Housing options
Familiar surroundings, whereby people feel A range of housing options in the local area
part of the local community, contribute to accommodate changing needs is regard-
to the age-friendliness of a city. For this ed as an important age-friendly feature.
reason, older people are reluctant to move. In some cities, there are a number of such
In Udine, older people mention they have housing options. In Melville, for example,
a kind of “psychological safety” in their older people have the choice of moving into
environment. In Tripoli, older people high- smaller accommodation, seniors’ housing
light the importance of their neighbours. In or care facilities. In many locations, how-
Dundalk, service providers recognize the ever, the need for more housing options
need to locate new homes close to where for older people is stressed. In Halifax, for
older people have lived in order to retain example, it was mentioned that some older
links with family and the community. In people were concerned about not being able
Himeji, concern is expressed that older to find accommodation in their local area
people lose their connection with the com- and did not have good knowledge about the
munity when they move to another facility. housing options in their area.

Changes to the city affect these feelings of In some cities, dedicated seniors’ housing
familiarity with the community. In Tokyo, options are provided. In Melville, seniors’
the lack of personal contact with neigh- housing complexes provide a range of ser-
bours that results from the development of vices, amenities and activities.
high-rise buildings is regarded as an age-
friendly barrier. In Sherbrooke, older people You've got a lot of social activities, you can
express concern about the lack of multigen- be busy the whole time or you can just close
erational spaces for interaction. In Geneva, your door and not join in, it's your choice.


PAGE 34


Dedicated seniors’ housing seems to be in Feeling safe in the home environment is
short supply in many cities and waiting another theme. In many cities, older people
times can be long, as mentioned in Halifax feel insecure and particularly fear living
and Himeji. Seniors’ housing also needs alone. Measures have been taken in some
to be affordable to be age-friendly. Older cities to improve the security in older
people in Saanich express concern about people’s homes. In Dundalk, for example,
the cost of seniors’ housing. There is also a surveillance cameras are used in some
clearly expressed preference in a few cities homes; in Geneva, there is secure access
for seniors’ housing to be integrated into to apartment buildings; in Saanich, older
the local community. In Melville, it is sug- people are provided with free home secu-
gested that small clusters of seniors’ hous- rity checks; and in Shanghai, there is a local
ing with small gardens be made available security patrol. In Himeji, some apartments
throughout the city, so that older people have emergency call monitoring devices to
are not isolated from the community and keep older people safe.
particularly from children. In Portland,
Nevertheless, there is an expressed need for
the need for multigenerational housing is
more to be done to ensure that older people
identified. In the Ruhr metropolitan region
feel secure at home. In Udaipur, more
and Sherbrooke, concern is expressed about
information about home security is recom-
creating ghettos of older people in large
mended, and in Saanich, it is suggested that
seniors’ housing complexes.
emergency alarms be installed.
9. Living environment
In some cities, the homes of older people
It is important for older people to have are not located in environments that are
sufficient space and privacy at home. safe from natural disasters. In La Plata,
In a handful of developing cities and in some homes are in flood-prone areas, and
Tuymazy, overcrowding is identified as a in Islamabad, older people are concerned
barrier for older people. In Delhi, for exam- about earthquakes.
ple, as the average family size has increased
houses have become overcrowded and older
people do not have sufficient space. In San
José, overcrowding has resulted from the
high housing costs that forces family mem-
bers to live together.

PAGE 35

Age-friendly housing checklist

Affordability Modifications
• Affordable housing is available for all • Housing is modified for older people as
older people. needed.

Essential services • Housing modifications are affordable.

• Essential services are provided that are • Equipment for housing modifications is
affordable to all. readily available.

Design • Financial assistance is provided for home
modifications.
• Housing is made of appropriate materials
and well-structured. • There is a good understanding of how
housing can be modified to meet the
• There is sufficient space to enable older needs of older people.
people to move around freely.
Maintenance
• Housing is appropriately equipped to
meet environmental conditions (e.g. ap- • Maintenance services are affordable for
propriate air-conditioning or heating). older people.

• Housing is adapted for older people, with • There are appropriately qualified and
even surfaces, passages wide enough for reliable service providers to undertake
wheelchairs, and appropriately designed maintenance work.
bathrooms, toilets and kitchens. • Public housing, rented accommodation
and common areas are well-maintained.

PAGE 36


Ageing in place • Sufficient and affordable housing dedicat-
ed to older people is provided in the local
• Housing is located close to services and
area.
facilities.
• There is a range of appropriate services
• Affordable services are provided to en-
and appropriate amenities and activities
able older people to remain at home, to
in older people’s housing facilities.
“age in place”.
• Older people’s housing is integrated in
• Older people are well-informed of the
the surrounding community.
services available to help them age in
place. Living environment
Community integration • Housing is not overcrowded.

• Housing design facilitates continued • Older people are comfortable in their
integration of older people into the com- housing environment.
munity. • Housing is not located in areas prone to
Housing options natural disasters.

• A range of appropriate and affordable • Older people feel safe in the environment
housing options is available for older they live in.
people, including frail and disabled older • Financial assistance is provided for hous-
people, in the local area. ing security measures.
• Older people are well-informed of the
available housing options.

PAGE 37

Part 8. Social participation

Overview of findings mobility issues, is important everywhere,
and even more so in developing countries
Social participation and social support
and those with economies in transition.
are strongly connected to good health and
well-being throughout life. Participating in 1. Accessible opportunities
leisure, social, cultural and spiritual activi-
Older people may be aware of events and
ties in the community, as well as with the
activities that exist in their community, but
family, allows older people to continue to
in the experience of many participants in
exercise their competence, to enjoy respect
the project these activities are inaccessible.
and esteem, and to maintain or establish
Personal safety, particularly at night, is
supportive and caring relationships. It
mentioned as one barrier in both developed
fosters social integration and is the key
and developing cities, including Halifax,
to staying informed. Yet the older people
La Plata, London and Rio de Janeiro. In
consulted by WHO indicate clearly that the
many cities, the locations are too distant
capacity to participate in formal and infor-
and transportation is difficult. Another
mal social life depends not only on the offer
common problem is the accessibility of the
of activities, but also on having adequate
buildings, especially for people with im-
access to transportation and facilities and
paired mobility, and the lack of adequate
on getting information about activities.
facilities such as toilets, appropriate seating
or smoke-free air. Another barrier men-
When I see my group colleagues, I feel very
well. tioned is restricted admission, such as the
requirement to be a member of an organi-
Older person, Mexico City zation.

In most cities, older people report that they They [older people with disabilities] find
participate actively in their communities it difficult to adjust as there are no proper
but feel there could be more possibilities arrangements for their sitting, toilet, etc.
for participation. They suggest having more Recreation for most of them would be talk-
and varied activities closer to where they ing to their friends or relatives on the phone
or occasional visits.
live. They would like activities that foster
integration within the community and with Caregiver, New Delhi
other age groups and cultures. The biggest
concerns are affordability and accessibility, Efforts in several cities to accommodate
especially for people with disabilities, and older people are recognized by the older
awareness of activities and events. Having people themselves and those who interact
appropriate support in place to enable
accessibility, particularly for people with

PAGE 38


with them. The municipal government in fewer opportunities exist for people who
Mayaguez reportedly organizes a variety of live outside those centres. There may also
activities at hours that are suitable for older be fewer options for people who are frail
people and provides transportation. An or disabled. Sometimes the schedules of
older person in Geneva notes that ameni- activities are rigid and older people need
ties are provided for people who are hard to make a choice between meeting their
of hearing. The availability of community personal needs, such as a regular nap in the
transport is reported from both Melbourne afternoon, and participating in an activ-
and Melville, conveniently located activi- ity. Locations where activities do occur
ties from Portland, and convenient tim- may not appeal to older people because of
ing of events and activities from Tripoli. noise levels or an emphasis on youth pro-
Participants in Dundalk suggest that allow- grammes. A variety of both targeted and
ing older people to bring a friend to events integrated activities provides a broad and
would help them participate. diverse range of choice for more people.
The range can include organized events
2. Affordable activities such as those in Himeiji, which are tar-
Activities that are free or at least af- geted to people over 80. In Jamaica, older
fordable facilitate participation by older people mention sporting events in which
adults. The cost of activities is a frequently older people can compete at various levels.
mentioned problem, especially in cities Portage La Prairie offers communal meals
in developing countries and those with and social contact as part of the attrac-
economies in transition. In some areas, tion. Outdoor activities, such as a walk in a
a variety of options exist only for people garden in Nairobi and a fine-weather stroll
with adequate incomes, and recreation in Moscow, are seen as simple and low cost
and leisure activities are only available to ways of encouraging social participation
the rich. Participants in Islamabad note,
It is reported from Udine that buildings are
however, that participation in activities is
offered to older people for activities such
affordable. Rio de Janeiro offers many free
as theatre, clubs, and Third Age University.
leisure activities, and Mexico City has free
In Tuymazy, there is a chess club, a histori-
or low-cost cultural events. In Dundalk,
cal re-enactment society and a club for the
Geneva and London, it is mentioned that
over-60s. Participants from Cancún say
because of high insurance costs, non-profit
they enjoy a “golden age” club, craft classes
organizations are obliged to charge prices
at the local monastery, and talks, music and
for activities that they know may discour-
dancing. All of the larger cities in the devel-
age participation.
oped regions, and the majority of cities in
3. Range of opportunities the developing countries, are said to offer a
variety of activities.
The existence of a variety of opportunities
that interest a broad range of older people
encourages more participation. Many cities
offer activities in major urban centres, but

PAGE 39

Religious activities and socializing within
I think where it falls down is on awareness
faith communities is an important form
– people knowing about what options are
of participation for older people in most of
out there.
the cities. Older people may be well-known
and esteemed within their local faith com- Service provider, Saanich
munity. These communities are usually
welcoming and inclusive too, facilitating In Dundalk, it is reported that organiza-
participation by people who may be at risk tions promote their activities by sending in-
of becoming isolated. It is reported from formation to older people before they retire.
Halifax, for example, that churches contrib- People who attend religious services and
ute to older people’s lives through activities other scheduled activities regularly tend to
such as card games, group meals, drives to hear about other activities through word of
church, and outreach to isolated people. In mouth. In San José, occupational associa-
Islamabad, it is noted that going to mosque tions promote their activities. A service
more than once a day contributes to social provider in Shanghai suggests more older
participation. people can be engaged if there is enough
publicity to attract participants.
At church we are listened to because of our
experience. People look up to us. 5. Encouraging participation and
addressing isolation
Older person, Jamaica
A consistent message from cities around
the world is that social participation is
Cultural, educational and traditional activi-
easier when the opportunities are close to
ties also remain important to older people
home and there are many of them. People
in many locations. Continuing education
in La Plata are dissatisﬁed with the lack
through Third Age Universities or through
of community centres in all neighbour-
courses at local community or seniors’
hoods, and in Udaipur, it is suggested that
centres provides ongoing engagement and
community centres be provided within
learning. Going to weddings and funerals
distances that are walkable for older people.
are opportunities to socialize. Older people
Participants in Dundalk and Shanghai
in Islamabad report enjoying frequent tra-
advise using facilities in the community,
ditional events such as weddings.
such as schools and recreation centres,
4. Awareness of activities and events for all community members, including
older people. This suggestion is echoed in
Several participants point out that older
Islamabad: a greater variety of leisure time
people need to know about activities and
activities in more locations.
opportunities in order to participate.

PAGE 40


Concerted efforts to encourage and mo-
I think there are lots of opportunities if
tivate older people to participate can
people are connected and have someone to
sometimes make the difference between
go with, but I think we can hear from the
participation and isolation. Many people lonely people and the marginalized through
who are involved with groups and clubs for organizations to rebuild social networks or
older people are very satisfied with their make some connections.
activities. However, some people express
Service provider, Halifax
reluctance to join associations and clubs
for a variety of reasons: they may not know
Caregivers, many of whom are older people
anyone, they may feel that they have to as-
themselves, are particularly vulnerable to
sociate with a particular political view, or
feeling isolated because their world is so
they find that the activities of that club are
centred on the person for whom they care.
not appealing.
Participants suggest more programmes and
options whereby older people with disabili-
Older people are reluctant to do anything.
ties can socialize outside the home without
Many were asked to join the club and
refused. requiring the presence of their caregiver.
Provision of day programmes and respite
Service provider, Himeji options are suggested as ways of helping
older caregivers and their charges to con-
Various reasons are given to explain why tinue to connect with society.
isolated older people find it more difficult
to associate with others. Their social con- Few men participate; they do not accept
tacts have become eroded after the death their age and/or they feel uncomfortable sur-
of their spouse and then gradually other rounded by so many women.
family members and friends. Their health
Older person, Cancún
may be declining, limiting their ability to
participate. Owing to societal changes,
The lack of social participation by men is
more women are in the workforce and
raised in several cities, including Cancún
are therefore not at home during the day
and Geneva. In some cities, nevertheless,
to visit older people. Outreach to isolated
there are activities intended to appeal to
older people in their homes provides a
men: in Melville, for example, there is a
social connection and a way of encouraging
“Men’s Shed” offering activities for men of
them to participate. In both Melbourne and
various ages. Older people in Istanbul men-
Shanghai, it is reported that organizations
tion that mosques are good places for men
take the initiative to seek out older people
to participate in society. Participants in
and invite them to activities.
Mexico City suggest more activities specifi-
cally for men, such as workshops or playing
dominos or cards.

PAGE 41

Some older people choose not to participate, If older people are unable to participate in
and respect for those who prefer to disen- activities outside of their homes, watching
gage is advised by participants in Portland. television remains their only source of lei-
sure and connection with society. The need
6. Integrating generations, cultures to integrate options for all generations and
and communities ages is reﬂected in the concerns of older
Older people want opportunities to social- people in some cities about the poor range
ize and integrate with other age groups and of programming choices available on televi-
cultures in their communities, activities sion, with little that appeals to them.
and families.
TV viewing is one option, but the kinds of
Older people feel they can participate in programmes that are being dished out these
different areas and with people of all ages, days on TV are not meant for family audi-
depending on the personal initiative and ences.
desire.
Older person, Udaipur
La Plata, Argentina
Older people in many areas want to partici-
Intergenerational activities are considered pate in their families in a meaningful way.
to be more desirable than activities for In Amman, for example, older people state
older people alone. These opportunities can that they do not want to be isolated from
be provided by sharing spaces and facili- their families. However, families may not
ties, such as in Saanich, where a seniors’ give enough consideration to older people,
centre is located in an unused part of an especially if there are expectations for
elementary school. In Ponce, some activi- grandparents to care for grandchildren or
ties involve older people in school settings. if there is little time to devote to activities
Programmes provided at community and with or for an older family member.
recreation centres are suggested for encour-
Better integration of generations is seen as
aging participation by people of diﬀerent
a way to counter ageism in society, which
ages and levels of ability.
can also mar older people’s experience
when participating, or even discourage
their participation. Older people express
the desire for more public education about
their experiences and the reality of aging,
and consider that other generations would
be more patient and respectful if they un-
derstood each other better.

PAGE 42


Intergenerational opportunities enrich the An open and welcoming neighbourhood
experience for all ages. Older people pass in the Ruhr metropolitan region pro-
on traditional practices and knowledge and vides a basis for newcomers to integrate.
experiences, while younger people oﬀer Newcomers in cities around the world are
information about newer practices and help at risk of becoming isolated, and older
older people navigate in a rapidly chang- people in this project recognize the need
ing society. Older people in Nairobi are to better integrate their activities to en-
engaged in traditional dances and skills, courage more participation by people from
enabling them to pass that knowledge to other places and cultures.
others.
I wish there were a way to foster more mul-
[Older people] are a source of “lived tradi- ticultural community activities in neighbour-
tion”. hoods where there’s a diverse population.

Caregiver, Nairobi Older person, Portland

The constitution and design of a neigh-
The solution must be for older residents to
bourhood can encourage the integration of
strive to accept new residents as their com-
people from various backgrounds, ages and panions. Also, it will be good for neighbours
cultures. Many neighbourhoods in cities to exchange greetings among themselves.
around the world are changing. Younger
Older person, Tokyo
people may not live in the same neigh-
bourhood as their older family members.
People may not have the same neighbours
throughout their lifetimes, and many cities
have growing populations of immigrants
who may not share the same language and
background as the majority population.

Villages became empty. They moved to the
cities. Now the villagers become older in
cities.


PAGE 43

Age-friendly social participation checklist

Accessibility of events and activities recreation centres, schools, libraries, com-
munity centres in residential neighbour-
• The location is convenient to older people in
hoods, parks and gardens.
their neighbourhoods, with affordable, flex-
ible transportation. • Facilities are accessible and equipped to en-
able participation by people with disabilities
• Older people have the option of participat-
or by those who require care.
ing with a friend or caregiver.
• Times of events are convenient for older
Promotion and awareness of activities
people during the day. • Activities and events are well-communi-
• Admission to an event is open (e.g. no cated to older people, including informa-
membership required) and admission, such tion about the activity, its accessibility and
as ticket purchasing, is a quick, one-stop transportation options.
process that does not require older people to Addressing isolation
queue for a long time.
• Personal invitations are sent to promote
Affordability activities and encourage participation.
• Events and activities and local attractions • Events are easy to attend, and no special
are affordable for older participants, with no skills (including literacy) are required.
hidden or additional costs (such as transpor-
• A club member who no longer attends
tation costs).
activities is kept on the club’s mailing and
• Voluntary organizations are supported by telephone lists unless the member asks to be
the public and private sectors to keep the taken off.
costs of activities for older people affordable.
• Organizations make efforts to engage iso-
Range of events and activities lated seniors through, for example, personal
visits or telephone calls.
• A wide variety of activities is available to ap-
peal to a diverse population of older people, Fostering community integration
each of whom has many potential interests.
• Community facilities promote shared and
• Community activities encourage the partici- multipurpose use by people of different ages
pation of people of different ages and cul- and interests and foster interaction among
tural backgrounds user groups.

Facilities and settings • Local gathering places and activities pro-
mote familiarity and exchange among
• Gatherings, including older people, occur
neighbourhood residents.
in a variety of community locations, such as

PAGE 44


Part 9. Respect and social inclusion

Overview of ﬁndings
You walk down the street and people smile
Older people report experiencing conﬂict- at you, you go into a shop and you’re served,
ing types of behaviour and attitudes towards the kids even say hello to you even if they
them. On the one hand, many feel they are don’t know you.
often respected, recognized and included, Older person, Melbourne
while on the other, they experience lack of
consideration in the community, in services In Jamaica and in Ponce, for example,
and in the family. This clash is explained in older people feel they are given priority
terms of a changing society and behavioural service in businesses and public places.
norms, lack of contact between generations, In Islamabad and Moscow, it is said that
and widespread ignorance about ageing and people give up their seats on buses to older
older people. It is clear from the consulta- adults. Examples of age-friendly services
tion that the respect and social inclusion of are mentioned in some cities: in Portage
older people depend on more than societal la Prairie, ballot papers are taken to the
change: factors such as culture, gender, homes of older people who are unable to go
health status and economic status play a to polling stations, and headsets are pro-
large role. The extent to which older people vided in churches for people with hearing
participate in the social, civic and economic impairments. In Mexico City, there is men-
life of the city is also closely linked to their tion of a bank whose employees are trained
experience of inclusion. to treat older people well, and at the end
of each month time is reserved exclusively
1. Respectful and disrespectful
behaviour to serve older people. It is also reported
that in some businesses in Jamaica, older
Project participants primarily comment on people can sit and wait to be served directly
the behaviour of people towards them that by employees assigned to the sitting areas.
shows respect and courtesy, or the oppo- Also, in Tokyo, older people note that busi-
site. As a whole, older people are respected nesses treat them well because most cus-
in the cities that have been studied: most tomers are older. In addition, older people
of the older people and other participants feel particularly respected and included in
in the focus groups recall the respect and seniors’ clubs. It is also noted that when
kindness expressed in everyday life towards older people themselves are respectful
older adults. and pleasant, they often receive the same
response from others.

PAGE 45

Nevertheless, participants in several cit-
Some old people keep going from one ofﬁce
ies also report disrespectful behaviour
to another without getting the information
towards older people. People are seen to
they are looking for because nobody takes
be impatient with older people who are time and has the courtesy to listen to them.
slower doing things, and rude gestures are
made towards older drivers. In Sherbrooke, Service provider, Mayaguez
they feel they are treated like children.
Older adults in Amman also feel they are Suggestions for promoting age-friendly
criticized by young people for their dif- services focus on training service providers
ferent clothes and way of talking. Some to understand how they can better respond
young people are said to lack good man- to the needs of older people.
ners (Tokyo and Udine), not to give up their
2. Ageism and ignorance
seats on buses (Portland) and to be verbally
or physically aggressive towards older In a society that gloriﬁes youth and change
people (Halifax, New Delhi and San José). in its popular imagery, the common nega-
tive images of age and ageing are often
They look at you as if your “use-by” date has evoked to explain disrespectful behaviour.
passed and they don’t want to serve you. Among the ageist biases reported, older
people are considered to be useless, less
intelligent, stingy and a burden. As a group,
there is a perception in developed coun-
Commercial and professional services are
tries that they are demanding and a drain
also said to be disrespectful or inconsider-
on public resources. Older people who are
ate of older people’s needs in some cities.
ill or who have disabilities are more likely
A caregiver in Amman noted that food in
than those who are healthy to be viewed
restaurants is not suitable for older people.
negatively.
Poor service in shops is noted in Melville.
In La Plata and Mayaguez, banks clerks
You are far more respected if you are healthy
and employees in public agencies are said
and not dependent on anyone, even by your
to not listen to the needs and complaints own child.
of older people. In San José, the example is
given of doctors having their prescriptions Older person, Tripoli
prepared even before seeing older patients.
Other concerns about service providers are Disrespectful behaviour and ageism are
expressed in, for instance, Nairobi, Ponce believed to result from ignorance of good
and Saanich. manners in some cities, the impersonal-
ity of large and growing cities, the lack of
interaction between generations, and the
general lack of public knowledge about

PAGE 46


ageing and older people. In Melbourne and
What you run into is the attitude towards
New Delhi, it is also recognized that there
seniors that needs to be readjusted. I find
is a gap between contemporary norms of
that’s the biggest problem, and I don’t know
individualism and the expectations of older how to educate younger people to respect
people. seniors.

3. Intergenerational interactions Older person, Portage la Prairie
and public education
Many express the opinion that community
There is a big disadvantage today … kids education should begin in primary school,
don’t have that privilege, getting to be with so that people learn cultural values and
old people … it pays an awful price.
to appreciate older people. In the view of
Older person, Portland participants, education about ageing should
include acquiring some understanding of
In nearly all the cities in the project, par- the difficulties caused by physical aging and
ticipants underlined the great need to common impairments. As stated in Jamaica,
facilitate and organize encounters between people would be able to prepare themselves
the generations, such as: working together; for that period of life by means of such edu-
participating in intergenerational planned cation. Almost all of the focus groups insist
events; older people participating in civic on the importance of inculcating respect
or historical education at school, or taking for older adults; in Udaipur, summer camps
care of children in public spaces; and young concentrating on social values are sug-
people helping of old people on a voluntary gested as a way to do this. Education about
basis. Every solution that promotes inter- ageing through age-friendly advertising in
generational activities is welcomed in most the media is proposed as well; examples are
cities. In Geneva, older people mention that given in Melville of a television programme
they themselves should take the first step in showing a young person relating to an older
meeting the younger generation. person, or of newspapers writing profiles of
local older people who have done a lot for
A common view is that public awareness the community. Advertisements and posters
about ageing and its issues is greatly lack- with attractive depictions of ageing are also
ing, and that education about ageing should mentioned, as well as presentations of older
begin early and extend to all groups in people in realistic and non-caricatured ways.
society.

PAGE 47

4. Place within the community
We rely on … the elderly as volunteers and
we certainly value their opinion and their
We don’t listen to the voices of the elderly in
input.
our societies.
Service provider, Saanich
Caregiver, Sherbrooke

Older adults are sometimes on committees
The role that older people play in the commu-
and boards of associations and organiza-
nity contributes to the respect and inclusion
tions, although in Sherbrooke it is said that
they enjoy. In a few cities, such as Moscow and
they still need to be better represented in
Tokyo, it is reported that they still maintain an
these areas. A point that is often raised is
active local leadership role and have an impact
that older people, their capacities and their
on public decisions. More often, however, par-
life experience have to be trusted and used
ticipants talk about the loss of these leadership
in decision-making. Their resources have to
responsibilities, and even reluctance to listen
be valued by the community, as suggested
to advice from older people, as reported in
in Dundalk and Mexico City. Service pro-
Melville. In Mayaguez, participants note that
viders in Portland add that older people can
the community is no longer used to taking
be important eyes and ears of a community.
older people’s opinions into account, and now
even decisions concerning older people are 5. Helpfulness of the community
taken without consulting them.
You know, people know one another, it’s not
Social engagement by older people positively
a big city. And this is it, when you know one
contributes to their esteem in the community. another, you help one another.
Older people seem to be very often involved
in volunteer services, in which they may play Older person, Portage la Prairie
an active role, as in Halifax and Melbourne.
Some jobs are reserved for older people, such Many comments concern the helpfulness
as in the supermarkets in Cancún. In Himeji, of people in the city towards older people
a programme called “Ask Older People” is and the reasons why communities are more
cited as an example of age-friendly inclu- or less inclusive. Smaller communities,
sion: this programme involves older people in where people have lived for a long time and
activities in which they have experience, such know each other, are seen to be friendlier
as gardening, organizing events or talking at and more inclusive: examples are Dundalk,
elementary schools. In Saanich, programmes Portage la Prairie and the Copacabana dis-
that connect older people with schools are trict of Rio de Janeiro.
reported.
People would notice if you weren’t at mass.

Older person, Dundalk

PAGE 48


In other, larger cities, comments are made gradually marginalized in their own fami-
to the effect that the city is “too big” and lies. In Islamabad, older people report that
impersonal, as in Istanbul. Neighbourhoods older women are not always consulted in
are seen to not be cohesive in Islamabad family matters. In New Delhi, grandparents
and Mexico City, and in London, the neigh- are said to become reduced to the state of
bours seem to change so quickly that people servants of their grandchildren. In San José,
no longer have the time to meet and get to some families even require the grandpar-
know one another. Nevertheless, more inclu- ents to work for money. Service providers in
sive communities can be fostered. Some of a few cities mention problems of abandon-
the focus groups propose promoting better ment or abuse of older people.
organized neighbourhoods with, for ex-
ample, local street committees (San José and 7. Economic exclusion
Tuymazy). The creation of places for neigh-
I’m feeling intimidated when I am in a store
bourhood meetings is suggested in Istanbul;
because I cannot afford to buy what I need.
this is reported to be already in place in La
Plata, where a part of the city hall is desig- Older person, Tuymazy
nated for older people’s meetings.
In several countries, the majority of older
6. Place in the family people have rather low incomes, and
In some cities, such as Amman and poverty at any age excludes people from so-
Udaipur, it is considered an advantage ciety. In the Russian Federation, many older
for older people to live with their family. people report that they feel excluded from
Remaining with the family signifies being the society because of their low income:
cared for, having affection and maintain- retired people fully depend on the small
ing social status in the view of people government allowances. It is reported in
from Tripoli. In Udaipur, older people are Jamaica and Mexico City that people often
not only consulted by their families when get very little personal financial aid from
decisions are made, but their views are the government, and that there is too much
accepted. Some older people mention that bureaucracy involved in obtaining entitle-
they have left their community of origin to ments. In Cancún, older people say that
go and live with their children in Cancún. they do not feel included in government
Family members are said to be helpful programmes.
and supportive, but at the same time it is
noted that family relationships are chang- For the first time, somebody thought about
ing. Comments are made, for instance in the needs of those who don’t have any
income [about the “Si Vale card”].
Istanbul and New Delhi, that families are
more scattered because children move Older person, Mexico City
away, and that younger generations do not
have much time to spend with older family In Mexico City, people highly appreci-
members. As a consequence, it is reported
from New Delhi that older people are

PAGE 49

ate the economic support adapted to the to lower prices and even free services, and a
economic condition of older people. This “Si Vale card” guaranteeing the poorest an
includes an ID card allowing them access income of US$ 80 per month.

Age-friendly respect and social inclusion checklist
Respectful and inclusive services Public education
• Older people are consulted by public, vol- • Learning about ageing and older people
untary and commercial services on ways is included in primary and secondary
to serve them better. school curricula.
• Public and commercial services provide • Older people are actively and regularly
services and products adapted to older involved in local school activities with
people’s needs and preferences. children and teachers.
• Services have helpful and courteous staff • Older people are provided opportunities
trained to respond to older people. to share their knowledge, history and
expertise with other generations.
Public images of ageing
Community inclusion
• The media include older people in public
imagery, depicting them positively and • Older people are included as full partners
without stereotypes. in community decision-making affecting
them.
Intergenerational and family
interactions • Older people are recognized by the com-
munity for their past as well as their pres-
• Community-wide settings, activities
ent contributions.
and events attract people of all ages by
accommodating age-specific needs and • Community action to strengthen neigh-
preferences. bourhood ties and support include older
residents as key informants, advisers,
• Older people are specifically included in
actors and beneficiaries.
community activities for “families”.
• Activities that bring generations together Economic inclusion
for mutual enjoyment and enrichment • Economically disadvantaged older people
are regularly held. enjoy access to public, voluntary and
private services and events.

PAGE 50


Part 10. Civic participation and
employment
Overview of findings 1. Volunteering options for older
people
Older people do not stop contributing to
their communities on retirement. Many
It’s been scientifically proven that volunteer-
continue to provide unpaid and voluntary ing can help you stay healthy and live longer.
work for their families and communities. In
some areas, economic circumstances force Older person, Halifax
older people to take paid work long after
they should have retired. An age-friendly In many of the participating cities, older
community provides options for older people are very actively involved in vol-
people to continue to contribute to their untary activities and enjoy many benefits
communities, through paid employment or from volunteering, including a sense of self
voluntary work if they so choose, and to be worth, of feeling active, and of maintain-
engaged in the political process. ing their health and social connections.
Participants in some cities report that there
Many older people would like to continue is a well-developed volunteer infrastruc-
working and some, in fact, do so. In ad- ture, such as volunteer resource centres or
dition, older people participating in the well-established voluntary organizations. In
WHO project expressed a desire and a most cities, participants say there are many
willingness to work as a volunteer in their opportunities to volunteer.
communities. Older people in most cities
have access to employment and volunteer In Ponce, older people like feeling useful
opportunities and in general feel respected through volunteering, and in Udine it is
for their contributions. Older people would noted that voluntary work is rewarding and
like to have more opportunities for em- prevents isolation. Older people in Geneva
ployment, and would like to see current volunteer within clubs and organizations.
employment and volunteer opportunities
better tailored to their needs and interests.
They would also like to see more efforts
made to encourage civic participation and
feel there are barriers to participation,
including physical barriers and cultural
stigmatization, surrounding participation
by older people.

PAGE 51

Despite the importance of volunteering, Several participants mention a general
participants note many barriers for older decline or change in the voluntary sector
people, such as finding out about volun- that affects older volunteers. This includes
teer opportunities, particularly those that a feeling that the ethic of volunteering is
would be most suited to them. Participants diminishing and that younger people are
want more opportunities and a greater failing to replace older people. In Halifax,
range of options. Creating central registers an older person considers that increasing
is suggested as a way to address this. In paperwork and insurance costs are contrib-
Melbourne, there is a project under way uting to the decline in the body of volun-
to use the Internet to match volunteers to teers. In Dundalk, it is suggested that insur-
opportunities, and a site that lists volunteer ance costs be waived for older volunteers.
opportunities exists in Portland. Older
Suggestions for improving volunteering
residents in Melville and Udaipur suggest
call for strengthening voluntary organiza-
creating a central database or register of
tions generally, establishing elderly volun-
volunteers, and participants in New Delhi
teer corps, and reimbursing volunteers for
suggest this could be run by an organiza-
expenses related to their work. Participants
tion such as HelpAge India. .
in Islamabad call for establishing a volun-
In addition, older people face problems get- teer corps of older people to work with the
ting to and from voluntary jobs, and some disadvantaged. In Mayaguez, incentives for
report physical limitations in completing older volunteers are suggested, and a ser-
the tasks assigned to them. In more devel- vice provider in Mexico City recommends
oped countries, some older people and ser- that volunteers should be reimbursed for
vice providers report that un-reimbursed their expenses. In Himeji, financial support
expenses (such as for petrol) or liability for voluntary organizations is suggested.
issues (on the part of the voluntary organi- In Shanghai, it is felt that a rewarding
zations) impede their ability or willingness and supportive social atmosphere would
to volunteer. encourage more people to volunteer. In
Tokyo, invitations are suggested as a way to
encourage older people to volunteer.

PAGE 52


2. Better employment options and families by caring for grandchildren, and in
more opportunities Mexico City it is felt that doing this kind of
work prevents older people from obtaining
My mother often talks about working, but proper employment.
I know she can’t manage. It’s just that they
like their own money. In places of low income and limited govern-
ment support, some older people feel that
Caregiver, Jamaica
they need to work whether they want to or
not. In some cities (e.g. Moscow, Nairobi
We need to assist the old people to remain and Ponce), focus group participants com-
employed. To work is a gift of health and of ment that the general level of unemploy-
life. ment and competition for jobs affect their
ability to find work.
Service provider, Tripoli

I cannot think of working. Why? Because you
Participants in many cities report that they
know, unemployment is high even in youth,
are eager and willing to work and have so how can I want to work?
the experience and qualifications to work.
However, older people face a variety of bar- Older person, Istanbul
riers in finding work or staying employed.
Policies that make retirement mandatory by Despite these barriers, older people are still
a certain arbitrary age, which varies among working in a number of cities. Older people
countries, are rejected by focus group in Tripoli note many benefits of continu-
participants. Some countries have policies ing to work, including income, combating
whereby any money earned after the “re- attitudes that older people are dependent,
tirement” age is deducted from government and continued social connections. Many
income support programmes or pensions, older people in Himeji are willing to work,
thus creating another barrier for older and would like to see more opportunities
people who want to continue working. for employment. Older people in Amman
suggest that the time and experience of
In several places, older people report that older people should be used as long as they
they are simply too frail to work, have are able to work, and that incentives be
difficulty getting to and from work, or do provided to encourage participation.
not feel safe travelling to or while at work.
Several cities note that the only job oppor-
tunities available to older people are often
menial, low-paid or generally undesirable.
In some areas, older people assist their

PAGE 53

A few places, largely in developed coun- There were also a number of suggestions
tries, do have policies, and some mention for improving the type or conditions of
specific companies that promote and value work. In some places, respondents feel that
older workers. In Mayaguez, service pro- the problem was not having the informa-
viders note that there is little absenteeism tion and tools to match the skills and needs
among older workers, and they also tend to of older workers with those of employers.
be punctual. In Melville, it is felt that work- Suggestions to remedy the situation include
places are changing and that there is a more better advertising of positions, creating
positive attitude to retaining older workers. databases to match older worker with jobs,
and developing a register listing older peo-
Participants have a number of sugges-
ple’s skills for potential employers to con-
tions for how to improve and create new
sult. In Istanbul, it is felt there should be
opportunities for employment for older
more support for women working at home,
people. These include offering incentives
and in New Delhi, sensitizing employers to
to employers who hire older people, having
the needs of older people is suggested.
government-sponsored employment pro-
grammes, creating public/private partner- 3. Flexibility to accommodate older
ships, and hiring older people to do public workers and volunteers
sector jobs.
I don’t want something I have to be there
Eliminating mandatory retirement, or age every week at 9:00; I got enough of that
restrictions for employment, is suggested working.
in the places where such legislation ex-
Older person, Portland
ists. Allowing people to work beyond the
retirement age is suggested in Dundalk, and
Flexibility in opportunities for older people
eliminating the legal age restriction for em-
in paid and voluntary work is cited as a way
ployment is proposed in Islamabad. Service
to better tailor such opportunities to older
providers in Sherbrooke feel there should
people.
be greater flexibility in legislation and poli-
cies to enable retired people to return to There are reports of rigid schedules, and a
work. One older person in Istanbul suggests feeling that voluntary jobs have become too
banning early retirement. professionalized. Participants propose that
opportunities for paid and voluntary work
should be structured in ways that accommo-
date older workers. Volunteering should be
more flexible and better suited to the needs
of older people. At several places, there is a
mention of more flexibility from employers
in terms of hours and seasonal or temporary
employment, and adjustment according to
the physical demands of the job.

PAGE 54


Older people in Geneva feel that voluntary Despite these reports of civic engage-
opportunities should be flexible and match ment, a significant proportion of cities also
the ability of those volunteering, taking report that opportunities for older people
into account the needs of older people who to engage in civic affairs are limited. Some
may tire more quickly. Service providers cities mention logistical barriers, such as
in Himeji feel that corporations should de- lack of transportation to civic functions,
velop an environment whereby older people lack of physical accommodation, and safety
can work without difficulty, and many cor- concerns at large civic events.
porations have this as a goal for the future.
Suggestions for improving civic engage-
Lighter workloads and more flexible sick ment include reserving seats for older peo-
leave for older employees are suggested in ple, improving accessibility at civic events
Halifax. Participants in London suggest (e.g. physical accessibility and providing
small projects that are interesting to older aids for the hard of hearing) and develop-
people and that make use of their skills. In ing or reinstating community boards and
Nairobi, Ponce and Tuymazy, participants other participatory bodies. Participants in
call for part-time opportunities. In Tokyo, Dundalk consider that better information
there is a human resource service for about civic activities would lead to more
temporary work, which may suit the needs participation. In Portland, it is suggested
of older people. Older people in Tuymazy that older people become involved by voic-
consider that consulting work is particu- ing their concerns to government officials.
larly suited to older people. Older people in La Plata call for more
opportunities for political participation by
4. Encouraging civic participation older people, and a role for older people in
Reports about the level of civic engagement solving the problems of the community. In
vary. In general, older people are interested Tokyo, it is suggested that older people be
in and willing to participate in civic func- allocated the specific civic role of taking
tions. In some places, elders already have an care of the concerns of other older people,
active voice through community boards or and participants in Saanich suggest that
seniors’ boards. Some cultures reportedly older people be engaged in planning for
value the experience and expertise of se- older people.
niors and routinely put them in positions of
authority, though some felt these positions
were largely symbolic. In Melville, there
are special-interest groups in which older
people participate, and in Mayaguez, there
is a high proportion of elders in the city leg-
islature. Participants in Tripoli report that
older people serve on boards of trustees,
and in Halifax, older people are involved in
helping with elections.

PAGE 55

5. Training 6. Entrepreneurial opportunities
Some participants suggest creating entrepre-
Now volunteering is a professionalized thing.
To be a volunteer you have to go through neurial opportunities for older people as a
training. way for them to earn money and participate
in the workforce. Financing or otherwise
Service provider, London
supporting self-employment opportunities
are suggested as ways of helping to sup-
Training is seen as a way to enable older port older people, and such ideas tend to
people to connect with the workforce and come from cities that also report general
to participate as volunteers. Some cities re- unemployment or low-income support for
port that elders feel they lack the job skills older people (e.g. Cancún, Mexico City, New
(largely surrounding the use of technology) Delhi, Ponce, Tripoli, Tuymazy and Udine).
needed to compete in the workplace. A few
cities report that older people would like Older people in several cities are actively
opportunities for training or retraining (al- involved in a variety of self-employed ac-
though this is a suggestion more commonly tivities, such as handicrafts and gardening.
made by service providers than the elderly In San José, older people ﬁnd opportunities
themselves). In New Delhi, pre-retirement as street vendors. There are opportunities
training and retraining is suggested. In for selling hand-made crafts in Cancún,
Amman, training older people for light jobs although older people there suggest that
that can provide some pay is called for. In having a location for a market would assist
Tuymazy, it is felt that training for older them. In Tripoli, it is suggested that non-
workers should focus on self-employment governmental organizations could assist
and small business opportunities. older people with small and home-based
businesses, and that farming could be
encouraged as an option for older people,
while in Tuymazy, farmers’ markets are
proposed as a way for older people to gener-
ate income.

PAGE 56


7. Valuing older peoples’ The degree to which older volunteers feel
contributions their contributions are appreciated and rec-
ognized also varies. Certificates of appre-
Reports of age discrimination in the work-
ciation are given out in Geneva. In Nairobi,
force are widespread. This is manifested in
service providers feel that older people are
a variety of ways, ranging from feelings of
seen as leaders because of their experience
disrespect by other workers to a flat refusal
and trustworthiness.
by employers to hire older workers. In some
cities it is apparently culturally unaccept- In Udine, it is considered that there should
able for older people to work after the be more appreciation for the experience of
retirement age. Some of these prejudices elders. Some suggest sensitivity training for
come from the older people themselves; employers about the needs and qualifica-
some report that they simply do not want to tion of older workers. In Mexico City, it is
work after having worked all their lives felt that societal recognition of the value
of older peoples’ expertise and presence in
There are reports of older people being
the workforce should be increased. Older
treated disrespectfully. Others men-
people in Jamaica suggest employing older
tion that it is difficult to work for people
people to teach younger people about the
younger than themselves, to take positions
culture of aging, addressing both participa-
that they consider to be beneath them, or to
tion and ageism.
work in environments where they feel they
are being patronized.

PAGE 57

Age-friendly civic participation and employment
checklist
Volunteering options • Employee organizations (e.g. trade
unions) support ﬂexible options, such as
• There is a range of options for older vol-
part-time and voluntary work, to enable
unteers to participate.
more participation by older workers.
• Voluntary organizations are well-devel-
• Employers are encouraged to employ and
oped, with infrastructure, training pro-
retain older workers.
grammes and a workforce of volunteers.
• The skills and interests of volunteers are
Training
matched to positions (e.g. register or • Training in post-retirement opportuni-
database). ties is provided for older workers.
• Volunteers are supported in their volun- • Retraining opportunities, such as train-
tary work, for example by being provided ing in new technologies, is available to
with transportation or having the cost of older workers.
parking reimbursed.
• Voluntary organizations provide training
Employment options for their positions.

• There is a range of opportunities for older Accessibility
people to work.
• Opportunities for voluntary or paid work
• Policy and legislation prevent discrimina- are known and promoted.
tion on the basis of age.
• Transportation to work is available.
• Retirement is a choice, not mandatory.
• Workplaces are adapted to meet the
• There are ﬂexible opportunities, with needs of disabled people.
options for part-time or seasonal employ-
• There is no cost to the worker of partici-
ment for older people.
pating in paid or voluntary work.
• There are employment programmes and
• There is support for organizations (e.g.
agencies for older workers.
funding or reduced insurance costs) to
recruit, train and retain older volunteers.

PAGE 58


Civic participation Entrepreneurship
• Advisory councils, boards of organiza- • There is support for older entrepreneurs
tions, etc. include older people. and opportunities for self-employment
(e.g. markets to sell farm produce and
• Support exists to enable older people to
crafts, small business training, and mi-
participate in meetings and civic events,
cro-ﬁnancing for older workers).
such as reserved seating, support for
people with disabilities, aids for the hard • Information designed to support small
of hearing, and transportation. and home-based business is in a formats
suitable for older workers.
• Policies, programmes and plans for older
people include contributions from older Pay
people.
• Older workers are fairly remunerated for
• Older people are encouraged to partici- their work.
pate.
• Volunteers are reimbursed for expenses
Valued contributions they incur while working.
• Older people are respected and acknowl- • Older workers’ earnings are not deducted
edged for their contributions. from pensions and other forms of income
support to which they are entitled.
• Employers and organizations are sensitive
to the needs of older workers.
• The beneﬁts of employing older workers
are promoted among employers.

PAGE 59

Part 11. Communication and information

Overview of findings 1. Widespread distribution
Focus group participants strongly agree In all cities, local community-wide media are
that staying connected with events and singled out as providers of useful information.
people and getting timely, practical infor- In developing countries and in the Russian
mation to manage life and meet personal Federation, the communication media famil-
needs is vital for active ageing. Participants iar to older people tend to be limited to radio,
in most cities in the developed world say television and newspapers. In developed
there is a variety of information from many countries, an abundance of general and tar-
different general and specialized media geted information of interest to older people
for older people, while in cities in develop- is described, from diverse sources including
ing countries, people in the focus groups the Internet. Valued everywhere is informa-
emphasize a few community-wide media, tion that reaches older people in their daily
mostly television, radio and newspapers. lives and activities, through direct personal
Yet the fear of missing information and delivery, telephone and distribution in key
of being left out of the mainstream is locations: community centres and bulletin
voiced almost everywhere. Rapidly evolv- boards, public services, libraries, stores, doc-
ing information and communication tors’ offices and health clinics. Older people in
technologies are both welcomed as use- Istanbul report that the telephone is the most
ful tools and criticized as instruments of universal and reliable way of communicat-
social exclusion. Regardless of the variety of ing with them. Governments and voluntary
communication choices and the volume of organizations are seen to have a major role
information available, the central concern in ensuring that information is widely avail-
expressed in the focus groups is to have able: systematic, effective public distribution
relevant information that is readily acces- services are valued as an age-friendly feature.
sible to older people with varying capacities In Himeji, there is said to be a well-structured
and resources. distribution of municipal information to resi-
dents’ associations, who pass it on to district
It becomes worst [sic] as you get older … leaders who then deliver it to every house-
as your faculties begin to fade, this kind hold. In cities where the private sector has yet
of thing appears to cause more in terms of to become aware of this growing grey market,
stress.
such as Tripoli, business too is mentioned as
Older person, Halifax a potential funder of information dissemi-
nation for older people. Distributing a local
directory of “age-friendly” services, suggested
by older people in Saanich, could appeal to a
chamber of commerce, for example.

PAGE 60


Affordable access to communication chan- ers in developing countries more often
nels and information is essential. Radio is face the problem of insufficient up-to-date
the mainstay of communication for older information on important matters, such as
people in Nairobi because it is cheap; in health, legal rights, benefit entitlements,
Udaipur, local notice boards are important services and community events. It is noted
in reaching people from lower socioeco- in La Plata that the general community me-
nomic groups. To ensure information ac- dia do not cover topics important for older
cess in Tuymazy, free newspaper subscrip- people in enough detail to be useful.
tions are provided to retirees by former
A frequent suggestion for making com-
employers. In Dundalk, the cost of a home
munication more age-friendly is to provide
telephone line is publicly subsidized for
more information targeted to older people
people over the age of 70. Free publications
through dedicated newspapers or regular
and public access to newspapers, computers
columns in the general press, as well as
and the Internet in community centres and
through specialized radio and television
libraries, at no or minimal cost, are age-
programmes. Another idea is to have com-
friendly features in other cities..
munication channels broaden their pro-
2. The right information at the right gramming and coverage of issues to include
time the interests of an older adult audience.
Older people in some cities complain that
Much information is available, but finding television in particular seems to exclude
needed information is complicated. their interests and tastes.
Caregiver, Moscow
People want information to be coordinated
in one easy-to-access service that is widely
Regardless of the number and variety of in- known throughout the community. In
formation sources, the preoccupation with Portland, the local county has a live 24-
getting relevant and timely information is hour telephone information service. Older
shared in cities at varying stages of devel- people consulted in New Delhi suggest that
opment. In some developed cities, such as a central and respected voluntary organi-
Geneva, managing the information over- zation, such as HelpAge India, collect and
load is difficult and important information organize a database of information relevant
may be missed. A frequent barrier is lack of to older people and make it available by
awareness of available information or ser- telephone. In Islamabad, a community
vices, or not knowing how to locate needed information room with newspapers and
information. The result is that older people television is recommended.
may not receive benefits or services to
which they are entitled or learn about them
too late to apply. Knowing how to deal with
intrusive telemarketing and identify frauds
and scams is another concern, voiced in a
few developed cities only. Older city dwell-

PAGE 61

3. Will someone speak to me? the attention of a real person who is helpful,
clear and unhurried is highly valued by older
Older people call into radio programmes at people around the world.
all hours.

Service provider, Mayaguez Every district has a mosque. The Arabic word
for mosque is a synonym for the place that
brings people together.
No matter how developed the city, word of
mouth is the principal and preferred means Older person, Tripoli
of communication for older people, both
through informal contacts with family and Age-friendly communication everywhere
friends and through clubs, associations, recognizes and uses these informal chan-
public meetings, community centres and nels to reach older people. One way is to
places of worship. Radio is a very popular regularly provide relevant information in
information source in many cities, with places where older people normally gather;
broadcasting in vernacular languages or another is to create social occasions to offer
with open-line programmes whereby call- information of interest to them. In Rio de
ers ask questions to experts or participate Janeiro, for instance, it is proposed using
in on-line discussions. The interpersonal the auditorium of the health care centre for
dimension of communication is very impor- educational lectures. A third strategy is to
tant, and it is repeated that staying active inform individuals who will in turn pass
and involved in the community is the best on the information to others, one-to-one.
way to remain informed. Regret is expressed These “key informants” can be volunteers,
about losing opportunities to interact with as suggested in Jamaica, social and health
others as a result of changes, such as new service providers or people in service
high-rise buildings in the neighbourhood, industries – estate agents, hairdressers,
the closing of community post offices, and postal workers, or the doormen in apart-
automating banking and other services. Oral ment buildings in Rio de Janeiro who know
communication is especially important for each resident and are a recognized source
older people who are visually impaired and of informal information and support.
for those who are not literate. Illiteracy rates
The problem of reaching those who are
are very high in the older adult population
socially isolated – older people who are out
in developing countries, and in developed
of touch with the world because they live
countries, older people on average have a
alone with significant impairments and
lower level of literacy than younger people.
have minimal family support – arises in
The “grapevine” works too because people
richer and poorer cities alike. E-mail and
trust the person providing the information
the Internet is one solution that is men-
and because they can ask questions until
they get what they want to know. Receiving

PAGE 62


tioned, but rarely. One-to-one outreach by Service automation adds a further layer of
trusted individuals is the favoured ap- complexity to daily transactions. Visual
proach, through volunteers who visit or displays and buttons on mobile telephones
telephone or through social service work- and electronic equipment are too small,
ers. Anticipating the locations outside the while automated banking, postal, parking
home where older people at risk of social and other ticket machines are all different,
isolation may be found is also suggested: are poorly lit and have unclear instructions.
the use of the district health clinic as a For people in a wheelchair, the panels are
distribution point for information about too high to reach. To make telephones ac-
services for older people with health prob- cessible to illiterate older people so they can
lems is suggested in San José. call family or services, a suggestion made
in Amman, is to colour-code the telephone
4. Age-friendly formats and design buttons and the telephone numbers.

I got a letter yesterday. They’re checking up, Automated answering services are a gen-
apparently, on what benefits you’re getting eral source of complaint: there is too much
…You’ve got to read it about four times to information given too quickly, the choices
really understand.
are confusing, and there is often no oppor-
Older person, London tunity to speak to a live person.

The single biggest universal barrier to com-
5. Information technology: boon
and bane
municating with older people is the visual
and auditory presentation of information. Information technology, especially comput-
Font size on text materials, mainly hard ers and the Internet, is appreciated by some
copy but also visual displays such as televi- older people for its comprehensiveness and
sion, is too small to read. Product labels and convenience. In Tripoli, older people say
instructions, particularly for medications, the Internet is a good way for them to stay
are hard to decipher. Page layout is often in touch with children who live far away,
confusing, with too much information in a perhaps in other countries.
small space. Auditory information is spo-
Nevertheless, many older people experience
ken too quickly and commercials on radio
a sense of exclusion because they do not use
and television make older people lose their
computers and the Internet. The conver-
train of thought. The language used is often
sion of direct services and documentation
too complicated, with many unfamiliar
to computer technology increases feelings
terms. Official forms – which are vital for
of exclusion. In developing countries and
receiving services and benefits – are espe-
cially difficult to understand.

Write simple, short with big letters.

Service provider, Mexico City

PAGE 63

the Russian Federation, computers are too
costly for many older people or just not
widely available in the community. In other Age-friendly communication
places, physical access to computers is pos-
sible but older people are totally unfamiliar Information offer
with the technology and are afraid they
• A basic, universal communications sys-
cannot learn. Affordable public access to
tem of written and broadcast media and
computers for older people in community
telephone reaches every resident.
centres, older people’s clubs, public services
and libraries is an important age-friendly • Regular and reliable distribution of
feature. Computer training, preferably information is assured by government or
adapted to individual needs and pace of voluntary organizations.
learning and given by a trusted person, is • Information is disseminated to reach
strongly advised. In Halifax, for example, older people close to their homes and
older people mention a permanent Internet where they conduct their usual activities
tutor who is available to help out older of daily life.
people individually, visiting them in their
• Information dissemination is coordinated
homes if requested.
in an accessible community service that
6. A Personal and collective is well-publicized – a “one-stop” informa-
responsibility tion centre.

Like other citizens, older people have a • Regular information and programme
personal responsibility to keep abreast of broadcasts of interest to older people
new information by staying involved in are offered in both regular and targeted
community activities, and to make an ef- media.
fort to adapt to change and take the risk to
Oral communication
learn. Collectively, governments, voluntary
organizations and the private sector are • Oral communication accessible to
responsible for removing the communica- older people is preferred, for instance
tion barriers that progressively cut older through public meetings, community
people off from others, particularly barriers
related to poverty, low literacy and dimin-
ished capacity.

PAGE 64


and information checklist
centres, clubs and the broadcast media, Automated communication and
and through individuals responsible for equipment
spreading the word one-to-one.
• Telephone answering services give
• People at risk of social isolation get instructions slowly and clearly and tell
information from trusted individuals callers how to repeat the message at any
with whom they may interact, such as time.
volunteer callers and visitors, home sup-
• Users have the choice of speaking to a
port workers, hairdressers, doormen or
real person or of leaving a message for
caretakers.
someone to call back.
• Individuals in public offices and busi-
• Electronic equipment, such as mobile
nesses provide friendly, person-to-person
telephones, radios, televisions, and bank
service on request.
and ticket machines, has large buttons
Printed information and big lettering.

• Printed information – including official • The display panel of bank, postal and
forms, television captions and text on vi- other service machines is well-illumi-
sual displays – has large lettering and the nated and can be reached by people of
main ideas are shown by clear headings different heights.
and bold-face type.
Computers and the Internet
Plain language • There is wide public access to comput-
• Print and spoken communication uses ers and the Internet, at no or minimal
simple, familiar words in short, straight- charge, in public places such as govern-
forward sentences. ment offices, community centres and
libraries.
• Tailored instructions and individual as-
sistance for users are readily available.

PAGE 65

Part 12. Community support and health
services

Overview of findings with existing services, it also shows that
older people in these cities have a level of
Health and support services are vital to
access to services that may be lacking in
maintaining health and independence in
other parts of the world.
the community. Many of the concerns
raised by older people, caregivers and In most collaborating cities, the supply,
service providers in the focus groups deal organization and financing of many health
with the availability of sufficient good and social services are decided by the state
quality, appropriate and accessible care. or national government rather than the city.
Participants in the WHO consultation Also, the supply and professional training
report their experiences from the context of health and social workers are outside
of very different systems with very different the city’s control. Nevertheless, health and
expectations; but nevertheless older people social services are delivered within a city
everywhere voice a clear desire for basic by local people in local establishments, and
health and income support. Health care community-based for-profit and voluntary
costs are perceived as too high everywhere, groups play an important role in delivering
and the desire for affordable care is consis- support and care. Public decision-makers
tently expressed. and the private and voluntary sectors at the
city level do have an influence on the num-
I’ve run into so many seniors that put off ber, range and location of services and on
going to the doctor, and their health just other aspects of the accessibility of facilities
deteriorates and deteriorates, because they
and services in their territory. Local service
don’t have the money.
authorities also provide staff training and
Older person, Portland set service performance standards. Civil
society plays a role in providing financial
In many cities in developing countries, a support and voluntary work. In reporting
basic shortage of necessary services and the findings and developing a checklist of
supplies is observed, and in others, services community and health service features in
are found to be poorly distributed. Some of an age-friendly city, the Guide focuses on
the most developed countries have, at the those aspects of community support and
same time, the greatest volume and range health services that are within the scope of
of health and community support services an age-friendly city’s influence.
and the greatest number of complaints.
While this certainly reflects dissatisfaction

PAGE 66


Health service issues dominate the focus Barrier-free structures and mobility within
group discussions in the majority of cit- health facilities is important, as is the safety
ies, reflecting their importance for active of the buildings. Among the barriers noted
ageing. Access to health care as well as to a are poorly maintained elevators and ramps
range of health services that are not strictly in Udaipur, poor building access for people
medical are major themes. Although less with disabilities and a lack of wheelchairs
attention is paid in general to commu- or walking frames for patients in Cancún,
nity support and social services, the key and overcrowded facilities in many other
attributes of an age-friendly city can be cities. Safety concerns or lack of space in
identified from the comments made by the nursing homes are raised in Amman, La
participants. Plata and Portage la Prairie.

1. Accessible care Another frequently mentioned barrier to
accessing care is insufficient knowledge
Having well-located, easily accessible health
about the health services available in the
services is fundamentally important for
city. As observed in Melbourne, if services
older people in every collaborating city.
are not known about they are not used.
Older people in cities such as Amman, Rio
Better advertising of local health services,
de Janeiro, Sherbrooke and Tokyo value
educating older people on the health
having health services near by, and in
system, coordination of information, and
Geneva and Shanghai, older people appre-
health information telephone services are
ciate good transportation to health facili-
suggested as possible solutions.
ties. Services that are far away or difficult
to reach are often seen as barriers. Public Finally, the attitudes of health service pro-
transportation is considered inadequate in viders towards older people are frequently
some places and in others, such as Delhi mentioned. Tuymazy is one of the few
and Mexico City, transportation for people places reporting the polite and friendly be-
with disabilities is reported to be a par- haviour of clinic receptionists and nurses.
ticular problem. Access to health care in Negative attitudes and poor communica-
emergency situations is a frequent concern. tion by health providers are common com-
Besides particular complaints, such as a plaints about care. Problems voiced include
lack of emergency care in some cities, those indifference, disrespect, uncaring attitudes,
consulted also mention that ambulance and treating older people as a burden or
services are either insufficient (Ponce) or as a drain on resources. General sugges-
too slow because of heavy traffic (Moscow). tions offered for improving the attitudes
Ways to minimize geographical barriers and behaviour of service providers are to
include the idea of co-locating or decentral- improve their communication skills and
izing services so they are available in all to train health professionals to treat older
neighbourhoods. Other ideas are to offer people better. In Amman, it is suggested
transportation by volunteers and to provide that young people be encouraged to do vol-
health emergency telephone services, as in untary work caring for older people.
Himeji, for older people living alone.

PAGE 67

at home. Older people in Mexico City are
When they came to wash and change her
pleased with the targeted vaccination cam-
they treated her like a piece of furniture – no
paign and free eyeglasses. Participants in
dignity, no respect.
Saanich suggest expanding seniors’ cen-
Older person, London tres into community wellness centres, and
people in Tuymazy propose providing older
2. A wider range of health services people with subsidized access to health re-
sorts (spas). In Islamabad and Mexico City,
In all cities, people’s views reflect the need
it is seen as a good idea to provide services
for a wide range of health services for older
in the local neighbourhoods rather that at a
people. The availability of various specific
central point.
forms of care for older people emerges
either as an asset or as a gap in the urban 4. Home care
landscape: geriatric clinic services and
hospital beds, adult day centres, care for the One very consistent theme is the need for
demented, mental health services, respite a wide range of home support and care
care and training for caregivers, rehabili- services – from help with shopping and/or
tation and palliative care are mentioned. providing meals to home visits from doc-
Along with services, a greater supply of tors and other service providers. With few
equipment is recommended, such as wheel- exceptions, the focus group participants
chairs, walking frames and hearing aids. want services that would allow them to tend
However, the health services that receive to their health and personal care needs in
the most attention worldwide are disease their own homes. Barriers experienced in
prevention and health promotion, home getting home care services include a gen-
care, and nursing (long-term care) homes. eral lack of such services, poor organization
of services, restrictive eligibility criteria,
3. Ageing well services high cost, and high turnover in home care
staff. Suggestions for improving home care
Older people and others in several cities
services depend very much on the context.
either report a lack of services or pro-
In several cities, especially in developing
grammes for disease prevention and health
countries, the message is simply “provide
promotion or include them in their sugges-
home care”. In other cities, comments focus
tions for improvement. In the list of im-
on how to improve the number or range of
portant services are preventive screening,
services (e.g. physiotherapy and psychologi-
physical activity, education on injury pre-
cal counselling) or their quality (e.g. provid-
vention, nutritional guidance, and mental
ing care soon after discharge from hospital,
health counselling. Age-friendly features
increasing the number of case managers,
reported in the Ruhr metropolitan area
and always being cared for by the same
include self-help groups or organizations
person). In some places, comments deal with
offering sports activities for fitness and
ways of managing costs, such as through
rehabilitation, and regular health checks
insurance coverage or by using the services
of a housekeeping cooperative enterprise,

PAGE 68


as mentioned in Sherbrooke. In Shanghai, are reported to be provided primarily by
caregivers report that people over 80 years families, religious institutions, charitable
of age, the widowed, people on a low income organizations or community groups.
and the disabled are entitled to one hour per Among the appreciated services offered by
day of free housekeeping. the community are cheaper meals for older
people in restaurants in Rio de Janeiro
5. Residential facilities for people and Geneva, help with pensions and other
unable to live at home entitlements in Jamaica, and a system for
A common concern is the lack of adequate screening contractors and handyman ser-
and affordable options in the city to care vices in Portland to ensure they are legiti-
for older people no longer able to live in mate. Community centres and centres for
their own homes. Lack of vacancies and older people are regarded as ideal locations
high cost are the most frequent complaints. for social services because of their conve-
Caregivers in Portage la Prairie observe nience, familiarity and accessibility.
that there is insufficient storage space for
Several barriers are noted, with more
personal effects in nursing homes, and
frequent and more acute problems in less
older people in Geneva suggest that nursing
developed regions: services are insufficient,
homes be located in the centre of the city
too costly, difficult to access or of poor
or have easy access to the centre. Serious
quality. As with health services, some par-
concerns are expressed in a few cities about
ticipants say that they simply do not have
safety, substandard care in homes for poor
good information about what is available
older people, insufficient personnel, and
or how to access it. Lack of coordination
suspected general sedation of residents.
among services, causing needlessly com-
Ideas for alternative models are proposed:
plicated application formalities and gaps in
caregivers in Amman suggest establishing
services, is also frequently raised as a prob-
small homes housing a few residents in-
lem. Suggestions for improving commu-
stead of the “huge” nursing homes; service
nity social services are varied. Improving
providers in Jamaica and older people in
coordination among services, adding more
Udine similarly call for such group homes
case managers and integrating service
offering housekeeping and some health and
teams are ideas proposed in cities with
personal care.
well-developed but somewhat fragmented
6. A network of community services service networks. Reducing or facilitating
administrative formalities are mentioned in
The scope of community social services and
the majority of cities, regardless of region.
the way in which they are provided vary
Co-locating social and health services in
enormously among cities. In some cities,
community or older people’s centres and
particularly in developed countries, social
providing more funding for services are
services are delivered, or funded, by the
other recommendations.
government. Elsewhere, support services

PAGE 69

Many social services are said to be needed
The doorman is really nice, he looks after
or improved, often to protect and care for
four older people in my building. He bathes
older people with low incomes who consti-
them, he is a cleaning man and in his lunch
tute the majority in many cities. In addition time he helps people.
to enhancing basic income support, older
people think their cities should establish Older person, Rio de Janeiro
or strengthen: shelter and protection for
homeless and destitute older people and 8. Other issues
people who have been abused; meals ser- Two other concerns are raised in a few cit-
vices and programmes; discounts on utili- ies: taking account of older people in emer-
ties for people with low incomes; registers gency situations and the lack of cemetery
of older people living alone; assistance in space. Although these issues are seldom
obtaining pensions and other entitlements; mentioned, they are nevertheless important
and spiritual support. A good example in expanding cities. Participants in two
described in Mexico City is an ID card for locations perceive a gap in support for older
older people, giving the holder access to people in emergencies, such as natural
lower prices and some free services. disasters and human conflicts. In Jamaica,
where hurricanes are frequent, older people
7. Volunteers wanted
comment that churches play a vital role in
A consistent theme is the need for vol- providing care during disasters. Service
unteers to help fill gaps in the health and providers in Amman suggest that the city
social services. More volunteers are wanted develop emergency and disaster plans that
to assist older people in clinics and hospi- include older people. Although it is not pro-
tals, as well as to deliver social services and posed in this context, a useful suggestion
home care, to provide transportation for for emergencies made in Dundalk is to have
shopping and appointments, or simply to a community register of older people living
walk the pets of older people who are no alone. The lack of sufficient cemetery space
longer able to do so themselves. Suggested is mentioned very briefly in Cancún and
sources of voluntary help are the “50+” Melbourne; as a solution, service providers
associations of young retirees, students in in the latter city suggest having a “vertical”
social and health services, and schoolchil- or layered cemetery.
dren. Intergenerational volunteering is an
idea repeated in several cities. Strong vol-
untary networks are easier to mobilize in
established communities where people feel
socially connected: a barrier mentioned in
Islamabad is that the city is relatively new
and people do not know each other well.

PAGE 70


Age-friendly community and health services
checklist
Service accessibility Offer of services
• Health and social services are well-dis- • An adequate range of health and com-
tributed throughout the city, are conve- munity support services is offered for
niently co-located, and can be reached promoting, maintaining and restoring
readily by all means of transportation. health.
• Residential care facilities, such as retire- • Home care services are offered that
ment homes and nursing homes, are include health services, personal care and
located close to services and residential housekeeping.
areas so that residents remain integrated
• Health and social services offered address
in the larger community.
the needs and concerns of older people.
• Service facilities are safely constructed
• Service professionals have appropriate
and are fully accessible for people with
skills and training to communicate with
disabilities.
and effectively serve older people.
• Clear and accessible information is pro-
Voluntary support
vided about the health and social services
for older people. • Volunteers of all ages are encouraged and
supported to assist older people in a wide
• Delivery of individual services is coor-
range of health and community settings.
dinated and with a minimum of bureau-
cracy. Emergency planning and care
• Administrative and service personnel • Emergency planning includes older peo-
treat older people with respect and sensi- ple, taking into account their needs and
tivity. capacities in preparing for and respond-
• Economic barriers impeding access to ing to emergencies.
health and community support services
are minimal.
• There is adequate access to designated
burial sites.

PAGE 71

Part 13. Wrapping up and moving
forward

Active ageing in an age-friendly city determinants of active ageing, more impor-
tant still are policies that reduce economic
The starting point for this Guide was the
inequalities in access to all the city’s struc-
concept that an age-friendly city encour-
tures, services and opportunities.
ages active ageing by optimizing opportuni-
ties for health, participation and security Design for diversity has emerged as a prime
in order to enhance quality of life as people characteristic of an age-friendly city that
age. The assets and barriers reported by is repeated often across many topic areas.
approximately 1500 older people and 750 Within the WHO life course perspective
caregivers and service providers consulted for active ageing described in Part 2, design
in this global project confirm this idea and for diversity is the key to supporting opti-
provide many examples to show how the mal capacity among high-functioning indi-
features of city reflect the determinants of viduals and enabling older people to func-
active ageing in many interconnected ways. tion who would otherwise become depen-
The city’s landscape, buildings, transpor- dent. According to the project participants,
tation system and housing contribute to it should be normal in an age-friendly city
confident mobility, healthy behaviour, for the natural and built environment to
social participation and self-determination anticipate users with different capacities
or, conversely, to fearful isolation, inactiv- instead of designing for the mythical “aver-
ity and social exclusion. A wide range of age” (i.e. young) person. An age-friendly
opportunities for age-integrated as well as city emphasizes enablement rather than
age-targeted social participation fosters disablement; it is friendly for all ages and
strong social connections and personal em- not just “elder-friendly”. There should be
powerment. Empowerment and self-worth enough public seating and toilet facilities;
are reinforced by a culture that recognizes, dropped curbs and ramps to buildings
respects and includes older people. Relevant should be standard features, and lights at
information in appropriate formats also pedestrian crossings should be safely timed.
contributes to personal empowerment, Building and housing design should be bar-
as well as to healthy types of behaviour. rier-free. Information materials and com-
Accessible and well-coordinated health munication technologies should be adapted
services have an obvious influence on older to suit diverse perceptual, intellectual and
people’s health status and health behaviour. cultural needs. In a word, spaces and struc-
Although opportunities for paid work in tures must be accessible.
urban settings are related to the economic

PAGE 72


Acknowledging and respecting diversity should watch out for each other’s safety
should characterize social and service and help and inform each other. Thanks to
relationships no less than physical struc- a network of trusted family, friends, neigh-
tures and materials. The participants in this bours and service providers, older members
WHO project make it clear that respect and of the community should feel integrated
consideration for the individual should be and safe. Moreover, there should be per-
major values on the street, at home and on sonalized outreach to older people at risk of
the road, in public and commercial servic- being socially isolated, and the economic,
es, in employment and in care settings. In linguistic or cultural barriers experienced
an age-friendly city, users of public spaces by many older people should be minimized.
should be considerate in sharing the ameni-
ties, and priority seating in public transport Integrated and mutually enhancing
and special needs stopping and parking urban features
areas should be respected. Services should The strong connections among the differ-
employ friendly staff who take the time ent aspects of city living made by people
to give personal assistance. Tradespeople consulted in the WHO project clearly show
should serve older people as well and as that an age-friendly city can only result
promptly as other clients. Employers and from an integrated approach centred on
agencies should offer flexible conditions how older people live. Taking this approach
and training to older workers and volun- means coordinating actions across differ-
teers. Communities should recognize older ent areas of city policy and services so that
people for their past contributions, not only they are mutually reinforcing. Based on the
for their current ones. Because education reports of the older people and others in
fosters awareness, schoolchildren should be the project, joint action that respects the
taught about ageing and older people and following relationships appears especially
the media should portray them in realistic important.
and non-stereotypical ways.
• Housing must be considered in connec-
The life course approach includes all ages tion with outdoor spaces and the rest of
within the process of promoting active the built environment such that older
ageing. It also embraces the value of in- people’s homes are located in areas safe
tergenerational solidarity. In the view of from natural hazards and are close to
the project participants, another impor- services, other age groups and civic at-
tant characteristic of an age-friendly city tractions that keep them integrated in the
is that it should foster solidarity between community, mobile and fit.
generations and within communities. An
• Transportation services and infrastruc-
age-friendly city should facilitate social
tures must always be linked to opportu-
relationships – in local services and in the
nities for social, civic and economic par-
activities that bring together people of all
ticipation, as well as to access to essential
ages. Opportunities for neighbours to get
health services.
to know each other should be fostered; they

PAGE 73

• Social inclusion of older people must Guide and checklists to initiate age-friendly
target social arenas and roles that carry city development. Currently being consid-
power and status in society, such as deci- ered are country-level networks, for exam-
sion-making in civic life, paid work and ple in Japan and Spain, as well as regional
media programming. “hubs” in the Middle East, in Canada and
in Latin America and the Caribbean. To
• Because knowledge is key to empower-
facilitate the spread of age-friendly cities,
ment, information about all aspects of
translation of the Guide into several lan-
city living must be accessible to everyone
guages is under way, including Chinese,
at all times.
French, German, Japanese, Portuguese and
Beyond the age-friendly city guide Spanish. Because the age-friendly cities idea
and checklists has much in common with the successful
This project is a starting point for many and effective Healthy Cities concept, an
more community development and re- active and mutually beneficial link between
search activities, as well as for the estab- the two networks is being pursued. Within
lishment of a larger global network of WHO, the Ageing and Life Course pro-
age-friendly communities. The next steps gramme will continue to provide an insti-
for collaborating cities and for WHO will tutional “home” for the WHO age-friendly
be to confirm the validity of the checklists. city initiative.
One city has already conducted site visits to
Focus group participants reported several
verify the barriers in the natural and built
examples of age-friendly practices in their
environments and in services that were re-
cities. Some of these have been very briefly
ported by older people. Others are return-
mentioned in this Guide. Another impor-
ing to the original focus group participants
tant step will be to obtain further informa-
to determine whether the features in the
tion about these initiatives from the project
Guide accurately capture what they said,
leaders and to publish an inventory of these
or are setting up focus groups with older
good practices. A conference to exchange
people in other locations to assess the level
local and international age-friendly city ini-
of agreement between their views and the
tiatives was held in June 2007 in the Ruhr
checklists. Another approach to validation
metropolitan area, sponsored by the State
will involve experts in the field of ageing,
Government of North Rhine Westphalia,
who will compare the checklists based on
to mark the selection of the city of Essen
the views of older people with evidence
as a European Capital of Culture for 2010.
from gerontological research and practice.
A further best practices meeting is being
At the same time, many other cities have planned for Istanbul, also in connection
expressed an interest in using the WHO with the selection of this city as the other
2010 European Capital of Culture. To gen-
erate more good practices from the WHO
research, experts and service providers will

PAGE 74


be invited to identify interventions corre- cities in different regions of the world, will
sponding to the age-friendly features in the be conducted to address these specific de-
checklists. The current checklists also will terminants, beginning with an initiative led
be tested in at least one location for their by the New York Academy of Medicine on
usefulness in creating age-friendly inter- the theme of “ageing in a foreign land”.
ventions.
Finally, non-urban communities must
The research leading to the Guide has yield- also become more age-friendly. In many
ed many rich findings worldwide, as well as countries, older people constitute a high
connections among researchers concerned percentage of the population in rural and
with ageing and the environment. With remote areas as a consequence of the emi-
the support of the Institute of Aging of the gration of younger people. Canadian federal
Canadian Institutes of Health Research, and provincial governments are leading a
collaboration among researchers is being project to identify the age-friendly com-
encouraged to advance knowledge about munity features in several small towns and
ageing in urban settings. Technical re- villages, and the results will eventually be
search papers are planned that will describe shared worldwide.
more fully the concept and methodology
There is already much enthusiasm for dis-
of the WHO-led research, more closely
seminating and adopting the Guide and
examine age-friendly settings in relation
checklist. New initiatives and collabora-
to active ageing, and reveal evidence of the
tors in a worldwide network are welcome.
convergences between ageing, urbanization
Active ageing in supportive, enabling cities
and globalization – the major forces shap-
will serve as one of the most effective ap-
ing the 21st century that are central to this
proaches to maintaining quality of life and
project.
prosperity in an increasingly older and
As stated earlier, the present research did more urban world.
not focus specifically on the cross-cut-
ting active ageing determinants of gender
and culture, although their effects are
mentioned sporadically in this Guide. For
example, it is observed in many cities that
men are less engaged in social activities
than women, and the situation of many old-
er women is described in the barriers faced
by economically disadvantaged groups in
many areas of urban living. Further focused
research, involving collaboration among

PAGE 75

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PAGE 76

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Ageing and Life Course
Family and Community Health
World Health Organization
Avenue Appia 20
CH-1211 Geneva 27
Switzerland
E-mail: activeageing@who.int
www.who.int/ageing/en
Fax: + 41 (0) 22 791 4839

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