Evidence

Evidence supporting the benefits of creating a Healthy Active environment

Research indicates a number of factors influence people’s ability to lead a Healthy and Active life:  

  • Healthy Active Ageing is best supported across the life-course, involving all ages.
  • Physical activity, such as regular walking, is of critical importance for the health and wellbeing of older people.
  • Social engagement and belonging are essential in providing the motivation for older people to maintain healthy levels of physical activity, including walking; and
  • Design plays an important role in facilitating both the physical activity and social engagement required to support the highest possible quality of life for older people, in particular, walkability.

Scope of evidence

The term ‘Healthy Active Ageing’ draws on the following World Health Organisation (WHO) policy frameworks and definitions:

  • Active ageing: ’the process of optimising opportunities for health, participation and security in order to enhance the quality of life as people age' [117]
  • Healthy ageing: the process of developing and maintaining the functional ability that enables wellbeing in older age [119]. This conceptualisation seeks to highlight the impact on ageing across the life course.
  • Age-friendly cities and communities: An age-friendly city or community is a good place to grow old. Age-friendly cities and communities foster healthy and active ageing, and thus, enable wellbeing throughout life [119]. This framework is used extensively by local governments across Australia (and the world).
  • Ageing in place: Alongside the Active Ageing framework, ageing in place highlights how age-friendly environments play an important role in supporting people ageing at home [119]. Ageing in place refers to supporting older people to live independently and remain in their own home for as long as possible [47] [54] [87].

Importantly, the World Health Organisation approach to Healthy Active Ageing has formed the foundation for best practice, with many projects worldwide drawing on the age-friendly cities framework [119].

Healthy Active ageing has formed the basis for the WHO’s ‘Global Age-Friendly Cities’ project., with the project offering a checklist of city features that influence the health and quality of life of older people in cities [120]. The design elements were grouped around eight key domains: outdoor spaces and buildings, transport, housing, social participation, respect and social inclusion, civic participation and employment, communication and information, and community support and health services. Although much of this research is centred on cities and urban environments, it is important to note that many age-friendly planning principles are equally relevant to people living in rural and remote areas.

 

“Fit for Life” - Active in the Park, free exercise class for older people
Age Friendly Melville

In this section, you can learn more about more about the eight key domains of Age-friendly Cities [116] and evidence that can support advocating for Healthy Active Ageing communities:
 

Transport

  • Importance of supporting mobility  
  • Importance of public transport  
  • Supporting independent modes of transport
  • Safety and its impact on independent movement  
  • Providing walkable communities

 Outdoor Spaces and Buildings

  • Universally accessible public buildings Safe environments  
  • Pleasant and welcoming built environments
  • The importance of landscape
  • Facilities within public places  
  • Safe and accessible pedestrian pathways

 Housing

  • Ageing in place  
  • Modifications to homes
  • Housing diversity
  • Delivery of affordable housing
  • Destination rich precincts

 Social Participation

  • Social engagement

 Respect and Social Inclusion

  • Cultural diversity and ageing
  • Ageing and Aboriginal and Torres Strait Islander Australians
  • Gender and sexual orientation
  • Living with dementia
  • A participatory approach
  • Creating inclusive activities

 Civic Participation and Employment

  • The importance of including older people
  •  Actively engaging older people in the planning process
  •  Employment options for older people

 Communication and Information

  • Digital literacy skills  
  • eHealth literacy
  • Digital social networks
  • Regional and rural digital connections  
  • Transnational social networks

 Community Support and Health Services

  • Cross-sectoral engagement

Summary of the evidence 

Transport

 

Importance of supporting mobility

Supporting all forms of mobility (including walking, affordable public transport and convenient private transport options) is critical to Healthy Active Ageing. Assistive devices, such as wheelchairs, can also help people move within their home and be mobile within the broader community. A network of universally accessible footpaths connecting people to age-friendly communities supports social and civic participation.

[68] [96] [94] [97] [121]

Importance of public transport

A variety of transport options (walking, cycling and public transport use) connecting key destinations is seen as critical for the creation of age-friendly cities. Alternative transport options, such as on-demand buses or paratransit, help seniors remain active and connected within the community.

[72] [83] [93]

Supporting independent modes of transport

Independence and a sense of agency are essential to older people. Helping older drivers to extend safe driving mobility by education, training and providing assistive technologies is important, as is finding alternative transport options when they can no longer drive safely.

[70]

Safety and its impact on independent movement

Perception of safety is a critical factor that determines older people’s decisions about mobility. Adopting crime prevention through environmental design approach, supporting passive surveillance outcomes and ensuring universally accessible routes between destinations improves safety outcomes.

[105] [121]

Providing walkable communities

Higher density underpins walkable neighbourhoods which promote physical activity across the life course, supported by the quality of footpaths, perceptions of safety and adequate road crossings.

[105]

Outdoor spaces and buildings

 

Universally accessible public buildings

Public buildings designed by integrating Universal Design principles can support older people to be more active, enhance their sense of security and provide opportunities to socialise.

Adopting universal design principles at the beginning of a project reduces the cost of having to modify existing structures to make them accessible for older adults and people with disabilities.

[116] [119]

Safe environments

Perceptions of public safety in outdoor spaces and public buildings are critical for older people. Safety directly affects their decisions to engage in physical activity. Providing good street lighting, a police presence and crime prevention through environmental design features can minimise crime.

[116] [121]

Pleasant and welcoming built environments

The aesthetics of the built environment and the surroundings can influence physical activity: an aesthetically pleasing environment is positively associated with increased mobility. Aesthetically pleasing, clean environments that are free from rubbish, noise pollution and harmful odours are positively associated with greater mobility by older adults. In contrast, environments with signs of decay lead to decreased mobility.

[23] [73] [74]

The importance of landscape

Presence of trees, gardens and plants are considered aesthetically pleasing and positively impact physical activity. Tree canopy is associated with a positive impact on the mental health of older people.

[24] [101]

Facilities within public places

Well-maintained and safe public open spaces with adequate shelter, toilet facilities and accessible seating are associated with increased levels of physical activity in older adults.

[61] [116]

Safe and accessible pedestrian pathways

Pedestrian-friendly walkways, underpasses and overpasses that are accessible and free from obstructions facilitate physical activity in older adults. Pavements should be well-maintained, smooth, level, non-slip and wide enough to accommodate mobility devices, such as wheelchairs, walkers and mobility scooters. High traffic speeds and inadequate separated pedestrian infrastructure can make older pedestrians feel unsafe and therefore limits their walking and physical activity.

[74] [82] [116]

Housing

 

Ageing in place

Housing choice, including service-supported housing, with universal design features, supports the capacity to age in place. Age-friendly environments play an important role in helping people ageing at home and living independently.

[12] [41] [47] [54] [87] [116] [119]

Modifications to homes

Most people prefer to age-in-place within their community and not in residential aged care accommodation. However, home adaptations and modifications can be necessary to facilitate ageing-in-place and preserve social connections.

[27] [49] [55] [58] [62] [103]

Housing diversity

Higher residential densities support a greater range of housing sizes, styles, housing tenure and price options, and can include flexible and adaptable housing for all ages and stages of life.

Providing diverse and innovative housing options within the existing community that supports physical and social activity can enable people to remain socially connected.

Future housing should be designed to enable ageing-in-place through whole-of-life design.

[3] [91] [105]

Delivery of affordable housing

Housing affordability and security of tenure are critical for seniors’ wellbeing, along with housing assistance for low-income seniors.

[15] [65] [91] [113]

Destination-rich precincts

Walkable areas, with mixed land uses, well-connected streets and good access to a variety of destinations fosters age-friendly communities and supports increased physical activity in older adults.

[15] [45]

Social participation

 

Social engagement is essential in encouraging physical activity. For example, seeing other older people exercising and exercising regularly with family and friends. Healthier, happier, more active and engaged older people also have a social and economic benefit for the whole of society.

[22] [85] [119]

Respect and social inclusion

 

Facilitating social engagement and belonging to combat loneliness and support physical activity for older people involves understanding the social, political, economic and cultural dimensions of ageing. Older people with a lower socio-economic status, along with older indigenous and female migrants, are among the poorest and most vulnerable members of our society. There are also significant differences between urban, suburban, rural, regional and remote communities.

[39] [43] [51]

Cultural diversity and ageing

Different cultural groups have diverse understandings of what it means to grow old, including the relevance and value of physical activity to health and wellbeing. Risks are exacerbated by their limited participation in preventative behaviours, such as sports. Importantly, developing a social network both within the same culture and with those from other cultures has been identified as supporting better health outcomes. 

[14] [18] [19] [29] [34] [38] [57] [84] [92]

Ageing and Aboriginal and Torres Strait Islander Australians

Research shows that Aboriginal and Torres Strait Islander Australians face more and unique social, cultural and financial barriers to engagement in physical activity, including lack of available, affordable and sustainable sporting facilities, and limited opportunities for engagement. Physical activity programs need to have a holistic vision of life and health to encourage participation and tap into cultural strengths including connection with land and waters and the importance of family.

 

[9] [46] [88]

Living with Dementia

Studies have shown a relationship between the development of cognitive impairment and dementia and lifestyle-related risk factors, such as physical inactivity.

[115]

Gender and sexual orientation

Many LGBTQI older people experience increased social isolation; therefore, services should be targeted to this age group. LGBTQ communities can provide support for those experiencing discrimination and recognise the higher rates of depression, isolation, cardiovascular disease and chronic pain.

[40] [81] [89] [98] [109]

A participatory approach

Physical and social environments affect the wellbeing of older people, and good socially inclusive, respectful governance models and comprehensive planning are critical for the development of age-friendly communities. Bottom-up participatory community consultation approach is most effective.

[31] [56] [66] [71]

Creating inclusive activities

Older people from marginal groups (Indigenous and Torres Strait Islanders, CaLD, LGBTQI and those living with dementia) face more and unique social, cultural and financial barriers to engagement in physical activity, including feeling unsafe or unwelcome in neighbourhoods. It is also important to offer low- or no-cost classes and involve older adults in program development to increase participation.

[14] [18] [29] [38] [46]

Civic participation and employment

 

The importance of including older people

Empowering older people via a 'top-down' policy action will enable and motivate activity, with 'bottom-up' engagement supporting activn older people.

[3] [108]

Actively engaging older people in the planning process

Older people should be actively engaged to improve the environment in which they live and to shape the conditions that favour the ageing process and improve their wellbeing.

[25] [35] [117]

Employment options for older people

An ageing population will have significant impacts on labour supply and economic output, and the delivery of appropriate, affordable and accessible infrastructure and services.

[85]

Communication and information

 

Digital literacy skills

Digital literacy is fundamental to a person's agency and ability to make informed decisions about health and their environment, while helping maintain social connections for wellbeing.

[48] [106]

eHealth literacy

Digital literacy, in particular, eHealth literacy, is critical for the health and wellbeing of older people.

[75] [110] [69]

Digital social networks

Digital technology plays an increasingly important role in social connection and support, which supports physical activity.

[112]

Regional and rural digital connections

Digital communication technologies support social connection across large distances and also support guided physical activity online.

[10]

Transnational social networks

Distant and migrant support networks play an essential role in the lives of older people, in particular those from CaLD backgrounds.

[11]

Community support and health services

 

Cross-sectoral engagement is required to deliver age-friendly built environments since no sector alone can foster the functional ability of older people. By using an ageing lens in planning, age-friendly communities can be created not just for the elderly but for the whole of the community.

[59] [120]