Skip to main content

Advertisement

Ageing and Urbanization: Can Cities be Designed to Foster Active Ageing?

Public Health Reviews volume 32, pages427–450 (2010) | Download Citation

Article metrics

Abstract

The world is currently experiencing two major demographic transitions: the ageing of populations, particularly in low and middle income countries, and urbanization. This paper briefly summarizes current theories on how the urban environment may influence the health and quality of life of an older person, reviews epidemiologic studies that have investigated this relationship, and highlights urban initiatives that foster active and healthy ageing.

The review identified an extensive body of research consistent with an association between the health of an older person and the physical, social and economic environment in which they live. However, most research in this field has been cross-sectional, and interpretation has been difficult due to numerous methodological limitations, particularly the risk of social selection biases.

More recently, a growing number of longitudinal studies have identified associations consistent with previous cross-sectional research, adding weight to these findings. In the last two years alone, at least thirteen new longitudinal studies examining these issues have been reported, with ten having positive findings. Unfortunately, few of these studies can yet point to specific pathways that may be amenable to intervention.

Concurrent with this research, a number of sizable programmes have been developed to make urban environments more supportive of older people. Both theory and the epidemiologic evidence appear to justify the optimism of these initiatives, although little evaluation has yet been undertaken of their impact.

References

  1. 1.

    UNDESA. World economic and social survey 2007: Development in an ageing world. United Nations Department of Social and Economic Affairs; 2007.

  2. 2.

    Sikken, B, Davis, N, Hayashi, C, and Olkkonen, H. The future of pensions and healthcare in a rapidly ageing world. Geneva: World Economic Forum; 2009.

  3. 3.

    United Nations. World population prospects: The 2008 revision population database. United Nations Population Division; 2010.

  4. 4.

    Diez Roux AV. Multilevel analysis in public health research. Annu Rev Public Health. 2000;21:171–92.

  5. 5.

    Diez Roux AV. The examination of neighborhood effects on health: Conceptual and methodological issues related to the presence of multiple levels of organization. In: Berkman L, editor. Neighborhoods and health. New York (NY): Oxford University Press; 2003. p. 45–64.

  6. 6.

    Bowling A, Stafford M. How do objective and subjective assessments of neighbourhood influence social and physical functioning in older age? Findings from a British survey of ageing. Soc Sci Med. 2007;64:2533–49.

  7. 7.

    UNFPA. State of the world population 2007: Unleashing the potential of urban growth. New York, (NY): United Nations Population Fund; 2007.

  8. 8.

    McLeod JD, Kessler RC. Socio-economic status differences in vulnerability to undesirable life events. J Health Soc Behav. 1990;31:162–72.

  9. 9.

    Ross CE, Mirowsky J. Neighbourhood disadvantage, disorder, and health. J Health Soc Behav. 2001;42:258–76.

  10. 10.

    Schulz AJ, Israel BA, Zenk SN Parker EA, Lichtenstein R, Shellman-Weir S, et al. Psychosocial stress and social support as mediators of relationships between income, length of residence and depressive symptoms among African American women on Detroit’s eastside. Soc Sci Med. 2006;62:510–22.

  11. 11.

    Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: A multilevel study of collective efficacy. Science. 1997;277:918–24. 1997.

  12. 12.

    Sampson RJ, Morenoff JD, Gannon-Rowley T. Assessing “neighborhood effects”: Social processes and new directions in research. Ann Rev Soc. 2002;28:443–78.

  13. 13.

    Lin N, Ye XL, Ensel WM. Social support and depressed mood: A structural analysis J Health Soc Behav. 1999;40:344–59.

  14. 14.

    Ostir GV, Eschbach K, Markides KS, Goodwin JS. Neighbourhood composition and depressive symptoms among older Mexican Americans. J Epidemiol Community Health. 2003;57:987–92.

  15. 15.

    Wheaton B. Stress, personal coping resources, and psychiatric symptoms: An investigation of interactive models. J Health Soc Behav. 1983:24:208–29.

  16. 16.

    Fitzpatrick KM, LaGory M. “Placing” health in an urban sociology: cities as mosaics of risk and protection. City Community. 2003;2:33–46.

  17. 17.

    Wheaton B. Models for the stress-buffering functions of coping resources. J Health Soc Behav. 1985;26:352–64.

  18. 18.

    Booth ML, Owen N, Bauman A, Clavisi O, Leslie E. Social-cognitive and perceived environment influences associated with physical activity in older Australians. Prev Med. 2000;31:15–22.

  19. 19.

    King AC, Castro C, Wilcox S, Eyler AA, Sallis JF, Brownson RC. Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women. Health Psychol. 2000;19:354–64.

  20. 20.

    King WC, Belle SH, Brach JS, Simkin-Silverman LR, Soska T, Kriska AM. Objective measures of neighborhood environment and physical activity in older women. Am J Prev Med. 2005;28:461–9.

  21. 21.

    Wilcox S, Bopp M, Oberrecht L, Kammermann SK, McElmurray CT. Psychosocial and perceived environmental correlates of physical activity in rural and older african american and white women. J Gerontol B Psychol Sci Soc Sci. 2003;58:329–37.

  22. 22.

    Lawton MP, Nahemow L. Ecology and the aging process. In: Eisdorfer C, Nahemow L, editors. The psychology of adult development and aging. Washington (DC): American Psychology Association; 1973. p. 464–88.

  23. 23.

    Alley D, Liebig P, Pynoos J, Banerjee T, Choi I. H. Creating elder-friendly communities: Preparations for an aging society. J Gerontol Soc Work. 2007;49:1–18.

  24. 24.

    Keller IM, Kalache A. Promoting healthy aging in cities: The Healthy Cities project in Europe. J Cross Cult Gerontol. 1997;12:287–98.

  25. 25.

    Balfour J L, Kaplan, GA. Neighborhood environment and loss of physical function in older adults: evidence from the Alameda County Study. Am J Epidemiol. 2002;155:507–15.

  26. 26.

    Diez Roux AV, Borrell LN, Haan M, Jackson SA, Schultz R. Neighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study. J Epidemiol Community Health. 2004;58:917–23.

  27. 27.

    Eschbach K, Ostir GV, Patel KV, Markides KS, Goodwin, JS. Neighborhood context and mortality among older Mexican Americans: Is there a barrio advantage? Am J Public Health. 2004;94:1807–12.

  28. 28.

    Li F, Fisher J, Brownson RC. A multilevel analysis of change in neighborhood walking activity in older adults. J Aging Phys Act. 2005;13:145–59.

  29. 29.

    Wen M, Christakis NA. Neighborhood effects on posthospitalization mortality: A population-based cohort study of the elderly in Chicago. Health Serv Res. 2005;40:1108–27.

  30. 30.

    Merkin SS, Roux AV, Coresh J, Fried LF, Jackson SA, Powe NR. Individual and neighborhood socioeconomic status and progressive chronic kidney disease in an elderly population: The Cardiovascular Health Study. Soc Sci Med. 2007;65:809–21.

  31. 31.

    Lang IA, Llewellyn DJ, Langa KM, Wallace RB, Melzer D. Neighbourhood deprivation and incident mobility disability in older adults. Age Ageing. 2008;37:403–10.

  32. 32.

    Jordan KP, Thomas E, Peat G, Wilkie R, Croft P. Social risks for disabling pain in older people: A prospective study of individual and area characteristics. Pain. 2008;137:652–61.

  33. 33.

    Brown SC, Mason CA, Perrino T, Lombard JL, Martinez F, Plater-Zyberk E, et al. Built environment and physical functioning in Hispanic elders: The role of “eyes on the street”. Environ Health Perspect. 2008;116:1300–7.

  34. 34.

    Beard JR, Cerda M, Blaney S, Ahern J, Vlahov D, Galea S. Neighborhood characteristics and change in depressive symptoms among older residents of New York City. Am J Public Health. 2009;99:1308–14.

  35. 35.

    Sheffield KM, Peek MK. Neighborhood context and cognitive decline in older Mexican Americans: Results from the Hispanic Established Populations for Epidemiologic Studies of the Elderly. Am J Epidemiol. 2009;169:1092–101.

  36. 36.

    Kravdal O. Mortality effects of average education in current and earlier municipality of residence among internal migrants, net of their own education. Soc Sci Med. 2009;69:1484–92.

  37. 37.

    Wight RG, Cummings JR, Karlamangla AS, Aneshensel CS. Urban neighborhood context and change in depressive symptoms in late life. J Gerontol B Psychol Sci Soc Sci. 2009;64:247–51.

  38. 38.

    Auchincloss AH, Diez Roux AV, Mujahid MS, Shen M, Bertoni AG, Carnethon MR. Neighborhood resources for physical activity and healthy foods and incidence of type 2 diabetes mellitus: The Multi-Ethnic study of Atherosclerosis. Arch Int Med. 2009;169:1698–704.

  39. 39.

    Li F, Harmer P, Cardinal BJ, Bosworth M, Johnson-Shelton D, Moore JM, et al. Built environment and 1-year change in weight and waist circumference in middle-aged and older adults: Portland Neighborhood Environment and Health Study. Am J Epidemiol. 2009;169:401–8.

  40. 40.

    Li F, Harmer P, Cardinal BJ, Vongjaturapat N. Built environment and changes in blood pressure in middle aged and older adults. Prev Med. 2009;48:237–41.

  41. 41.

    Lee IM, Ewing R, Sesso HD. The built environment and physical activity levels: The Harvard Alumni Health Study. Am J Prev Med. 2009;37:293–8.

  42. 42.

    Clarke P, Ailshire JA, Lantz P. Urban built environments and trajectories of mobility disability: Findings from a national sample of community-dwelling American adults (1986–2001). Soc Sci Med. 2009;69:964–70.

  43. 43.

    Schootman M, Andresen EM, Wolinsky FD, Malmstrom TK, Miller JP, Miller DK. Neighborhood conditions and risk of incident lower-body functional limitations among middle-aged African Americans. Am J Epidemiol. 2006;163:450–8.

  44. 44.

    Clark CR, Kawachi I, Ryan L, Ertel K, Fay ME, Berkman LF. Perceived neighborhood safety and incident mobility disability among elders: The hazards of poverty. BMC Public Health. 2009;9:162.

  45. 45.

    Oakes JM. The (mis)estimation of neighborhood effects: Causal inference for a practicable social epidemiology. Soc Sci Med. 2004;58:1929–52.

  46. 46.

    Leslie E. Cerin E. Are perceptions of the local environment related to neighbourhood satisfaction and mental health in adults? Prev Med. 2008;47:273–8.

  47. 47.

    Michael Y, Beard T, Choi D, Farquhar S, Carlson N. Measuring the influence of built neighborhood environments on walking in older adults. J Aging Phys Act. 2006;14:302–12.

  48. 48.

    Yen IH, Michael YL, Perdue L. Neighborhood environment in studies of health of older adults: A systematic review. Am J Prev Med. 2009;37:455–63.

  49. 49.

    Saelens BE, Handy SL. Built environment correlates of walking: a review. Med Sci Sports Exerc. 2008;40:S550–66.

  50. 50.

    Mair C, Diez Roux A, Galea S. Are Neighborhood characteristics associated with depressive symptoms? A review of evidence. J Epidemiol Community Health. 2008;62:940–6.

  51. 51.

    Berke EM, Gottlieb LM, Moudon AV, Larson EB. Protective association between neighborhood walkability and depression in older men. J Am Geriatr Soc. 2007;55:526–33.

  52. 52.

    Aneshensel CS, Wight RG, Miller-Martinez D, Botticello AL, Karlamangla AS, Seeman TE. Urban neighborhoods and depressive symptoms among older adults. J Gerontol B Psychol Sci Soc Sci. 2007;62:S52–9.

  53. 53.

    Kubzansky LD, Subramanian SV, Kawachi I, Fay ME, Soobader MJ, Berkman LF. Neighborhood contextual influences on depressive symptoms in the elderly. Am J Epidemiol. 2005;162:253–60.

  54. 54.

    Berke EM, Koepsell TD, Moudon AV, Hoskins RE, Larson EB. Association of the built environment with physical activity and obesity in older persons. Am J Public Health. 2007;97:486–92.

  55. 55.

    Hillsdon M, Lawlor DA, Ebrahim S, Morris JN. Physical activity in older women: Associations with area deprivation and with socioeconomic position over the life course: Observations in the British Women’s Heart and Health Study. J Epidemiol Community Health. 2008;62:344–50.

  56. 56.

    Fuentes M, Hart-Johnson T, Green CR. The association among neighborhood socioeconomic status, race and chronic pain in black and white older adults. J Natl Med Assoc. 2007;99:1160–9.

  57. 57.

    Lang IA, Gibbs SJ, Steel N, Melzer D. Neighbourhood deprivation and dental service use: A cross-sectional analysis of older people in England. J Public Health. 2008;30:472–8.

  58. 58.

    Lang IA, Llewellyn DJ, Langa KM, Wallace RB, Huppert FA, Melzer D. Neighborhood deprivation, individual socioeconomic status, and cognitive function in older people: Analyses from the English Longitudinal Study of Ageing. J Am Geriatr Soc. 2008;56:191–8.

  59. 59.

    Wight RG, Aneshensel CS, Miller-Martinez D, Botticello A. L, Cummings JR, Karlamangla AS, Seeman TE. Urban neighborhood context, educational attainment, and cognitive function among older adults. Am J Epidemiol. 2006;163:1071–8.

  60. 60.

    Nordstrom CK, Diez Roux AV, Jackson SA, Gardin JM. The association of personal and neighborhood socioeconomic indicators with subclinical cardiovascular disease in an elderly cohort. The cardiovascular health study. Soc Sci Med. 2004;59:2139–47.

  61. 61.

    Schieman S, Pearlin LI, Meersman SC. Neighborhood disadvantage and anger among older adults: Social comparisons as effect modifiers. J Health Soc Behav. 2006;47:156–72.

  62. 62.

    Wight RG, Cummings JR, Miller-Martinez D, Karlamangla AS, Seeman TE, Aneshensel CS. A multilevel analysis of urban neighborhood socioeconomic disadvantage and health in late life. Soc Sci Med. 2008;66:862–72.

  63. 63.

    Cagney KA, Browning CR, Wen M. Racial disparities in self-rated health at older ages: What difference does the neighborhood make? J Gerontol B Psychol Sci Soc Sci. 2005;60:S181–90.

  64. 64.

    Subramanian SV, Kubzansky L, Berkman L, Fay M, Kawachi I. Neighborhood effects on the self-rated health of elders: Uncovering the relative importance of structural and service-related neighborhood environments. J Gerontol B Psychol Sci Soc Sci. 2006;61:S153–60.

  65. 65.

    Robert SA Ruel E. Racial segregation and health disparities between Black and White older adults. J Gerontol B Psychol Sci Soc Sci. 2006;61:S203–11.

  66. 66.

    Patel KV, Eschbach K, Rudkin LL, Peek MK, Markides KS. Neighborhood context and self-rated health in older Mexican Americans. Ann Epidemiol. 2003;13:620–8.

  67. 67.

    Breeze E, Jones DA, Wilkinson P, Bulpitt CJ, Grundy C, Latif AM, Fletcher AE. Area deprivation, social class, and quality of life among people aged 75 years and over in Britain. Int J Epidemiol. 2005;34:276–83.

  68. 68.

    Freedman VA, Grafova IB, Schoeni RF, Rogowski J. Neighborhoods and disability in later life. Soc Sci Med. 2008;66:2253–67.

  69. 69.

    Beard JR, Blaney S, Cerda M, Frye V, Lovasi GS, Ompad D, et al. Neighborhood characteristics and disability in older adults. J Gerontol B Psychol Sci Soc Sci. 2009;64:252–7.

  70. 70.

    Clarke P, George LK. The role of the built environment in the disablement process. Am J Public Health. 2005;95:1933–9.

  71. 71.

    Schmitz N, Nitka D, Gariepy G, Malla A, Wang J, Boyer R, et al. Association between neighborhood-level deprivation and disability in a community sample of people with diabetes. Diabetes Care. 2009;32:1998–2004.

  72. 72.

    Pikhartova J, Chandola T, Kubinova R, Bobak M, Nicholson A, Pikhart H. Neighbourhood socioeconomic indicators and depressive symptoms in the Czech Republic: A population based study. Int J Public Health. 2009;54:283–93.

  73. 73.

    Hybels CF, Blazer DG, Pieper CF., Burchett BM, Hays JC, Fillenbaum GG, et al. Sociodemographic characteristics of the neighborhood and depressive symptoms in older adults: Using multilevel modeling in geriatric psychiatry. Am J Geriatr Psychiatry. 2006;14:498–506.

  74. 74.

    Walters K, Breeze E, Wilkinson P, Price GM, Bulpitt CJ, Fletcher A. Local area deprivation and urban-rural differences in anxiety and depression among people older than 75 years in Britain. Am J Public Health. 2004;94:1768–74.

  75. 75.

    Wen M, Hawkley LC, Cacioppo JT. Objective and perceived neighborhood environment, individual SES and psychosocial factors, and self-rated health: An analysis of older adults in Cook County, Illinois. Soc Sci Med. 2006;63:2575–90.

  76. 76.

    Winkleby M, Cubbin C, Ahn D. Effect of cross-level interaction between individual and neighborhood socioeconomic status on adult mortality rates. Am J Public Health. 2006;96:2145–53.

  77. 77.

    Augustin T, Glass TA, James BD, Schwartz BS. Neighborhood psychosocial hazards and cardiovascular disease: The Baltimore Memory Study. Am J Public Health 2008;98;1664–70.

  78. 78.

    Li F, Harmer PA, Cardinal BJ, Bosworth M, Acock A, Johnson-Shelton D, Moore JM. Built environment, adiposity, and physical activity in adults aged 50–75. Am J Prev Med. 2008;35:38–46.

  79. 79.

    Li F, Fisher KJ, Brownson RC, Bosworth M. Multilevel modelling of built environment characteristics related to neighbourhood walking activity in older adults. J Epidemiol Community Health. 2005;59:558–64.

  80. 80.

    Booth ML, Owen N, Bauman A, Clavisi O, Leslie E. Social-cognitive and perceived environment influences associated with physical activity in older Australians. Prev Med. 2000;31:15–22.

  81. 81.

    Mendes de Leon CF, Cagney KA, Bienias JL, Barnes LL, Skarupski KA, Scherr PA, Evans DA. Neighborhood social cohesion and disorder in relation to walking in community-dwelling older adults: A multilevel analysis. J Aging Health. 2009;21:155–71.

  82. 82.

    Fisher KJ, Li F, Michael Y, Cleveland M. Neighborhood-level influences on physical activity among older adults: A multilevel analysis. J Aging Phys Act. 2004;12:45–63.

  83. 83.

    Gauvin L, Riva M, Barnett T, Richard L, Craig CL, Spivock M, et al. Association between neighborhood active living potential and walking. Am J Epidemiol. 2008;167;944–53.

  84. 84.

    Grafova IB, Freedman VA, Kumar R, Rogowski J. Neighborhoods and obesity in later life.[Erratum appears in Am J Public Health. 2009;99:392]. Am J Public Health. 2008;98:2065–71.

  85. 85.

    Jaffe DH, Eisenbach Z, YD, Manor O. Does living in a religiously affiliated neighborhood lower mortality? Ann Epidemiol. 2005;15:804–10.

  86. 86.

    Nagel CL, Carlson NE, Bosworth M, Michael YL. The relation between neighborhood built environment and walking activity among older adults. Am J Epidemiol 2008;168:461–8.

  87. 87.

    Balfour JL, Kaplan GA. Neighborhood environment and loss of physical function in older adults: Evidence from the Alameda County Study. Am J Epidemiol 2002;155:507–15.

  88. 88

    A Blueprint for Action: Developing Livable Communities for All Ages. Partners for Livable Communities (Partners) and the National Association of Area Agencies on Aging. 2010.

  89. 89.

    Partners for Livable Communities. Aging in Place Technical Assistance Guide. Washington, (DC): Partners for Livable Communities; 2007.

  90. 90.

    Kochera A, Straight A, Guterbok, T. Beyond 50.05: A report to the nation on Livable Communities Creating Environments for Successful Aging. 2010. Washington (DC): AARP.

  91. 91.

    National Council on Disability. Livable Communities for Adults with Disabilities. Washington (DC): National Council on Disability; 2004.

  92. 92.

    The AdvantAGE Initiative. 2010. Available from URL: http://www.vnsny.org/advantage/ (Accessed 5 April 2011).

  93. 93.

    Austin C, Flux D, Ghali L, Hartley D, Holinda D, McClelland R, et al. A place to call home: Final report of the Elder Friendly Communities Project. City of Calgary (Canada): 2001.

  94. 94.

    Valuing Older People. Manchester (UK): Manchester City Council; 2010.

  95. 95.

    ACT Strategic Plan for Positive Ageing 2010–2014: Towards an Age-Friendly City. Canberra (Australia): ACT Government; 2010.

  96. 96.

    Healthy cities and urban governance. 2010.

  97. 97.

    WHO. WHO Age-Friendly Environments Programme. Geneva: World Health Organization; 2010.

Download references

Author information

Affiliations

  1. Department of Ageing and Life Course, World Health Organization, 20, Avenue Appia, CH-1211, Geneva 27, Switzerland

    • John R. Beard MBBS, PhD
    •  & Charles Petitot MD, MPH

Authors

  1. Search for John R. Beard MBBS, PhD in:

  2. Search for Charles Petitot MD, MPH in:

Corresponding author

Correspondence to John R. Beard MBBS, PhD.

Additional information

Recommended Citation: Beard JR, Petitot C. Ageing and Urbanization: Can Cities be Designed to Foster Active Ageing? Public Health Reviews. 2010;32:427–50.

Rights and permissions

Reprints and Permissions

About this article

Key words

  • Ageing
  • neighbourhood
  • urban
  • socioeconomic

Public Health Reviews

ISSN: 2107-6952

Contact us