The biggest challenge gerontologists are presently facing is to incorporate the phenomenon of ageing in society and keeping our older persons as independent and integrated in society as possible. For citizens to be as active as possible, policymakers have to plan for age-friendly environments.
An age-friendly community is an inclusive and accessible community environment that optimises opportunities for health, participation and security for all people, in order that quality of life and dignity are ensured as people age.
For a community to be age-friendly, policies, services and settings need to recognise the wide range of capabilities and resources among older persons; anticipate and respond to ageing-related needs and preferences; respect older person’s decisions and lifestyles; and promote inclusion of older persons in the community.
The World Health Organisation guide for age-friendliness living highlights the advantages and barriers that older citizens experience in eight areas of community living. To assess and implement changes, these eight domains need to be addressed. These include outdoor spaces and buildings; transportations; housing; social participation; respect and social inclusion; civic participation and employment; communications and information and community support; and health services.
Older persons want a choice about where and how they age in place. ‘Ageing in place’ is seen as an advantage in terms of a sense of attachment or connection and feelings of security and familiarity in relation to both homes and communities. When older persons age in place, they will have a sense of identity both through independence and autonomy and through caring relationships and roles in the places they live. This cohort prefer to age in place because it is seen as enabling them to maintain independence, autonomy and connection to social support, including family and friends.
Ageing in place is a complex phenomenon whereby it needs to consider not only housing options but also transportation, recreational opportunities and amenities that facilitate physical activity, social interaction, cultural engagement and ongoing education.
The Madrid Report on Ageing emphasised a need for governments, in partnership with civil society, to promote age-integrated communities; invest in local infrastructure and environmental design to support multigenerational multicultural communities; and to consider affordability and equity of access and choice.
Policymakers need to understand that to promote the physical and psychosocial well-being of the old generation, changes in the physical and social infrastructure must be made. This means having a community with resources including housing; transportation and mobility; health; social interaction; productivity; cultural religious involvement; education; and leisure activities.
Policymakers are encouraged to focus on issues related to the physical and social environment like accessibility to green spaces, home adaptations and volunteering. The provision of reliable, affordable and accessible public transport is an important fact in encouraging and enabling older persons to participate in family and community life as well as assisting older persons to remain mobile and independent.
Maintained footpaths, provision of bus shelters and nearby bus stops can result in older persons feeling less isolated, as well as enabling mobility and walkability. Social environment can provide social support
opportunities, for education, learning employment and volunteering. Remaining engaged in lifelong learning can assist older people in developing new skills. These skills can create or enhance self-confidence allowing the older person to stay independent.
We need to walk the talk in order to enhance partnerships among healthcare services and ageing services to help Maltese older persons thrive in their communities as they age
In a study I conducted titled ‘Towards age-friendly cities and communities: A case study in the locality of Sliema’, it was concluded that in Sliema, the main stakeholders working towards an age-friendly Sliema are primarily the local council, the parishes and other NGOs.
A total of 181 senior residents participated in the study. Participants were almost evenly split between males and females: 48 per cent were females and 52 per cent were males. Eight-three of participants pertained to the 60-80 age group. 24.3 per cent scored Sliema to be an excellent town to live in, while 27 per cent described it as excellent to retire in. This finding shows that notwithstanding the fact that the overall score for age-friendliness in Sliema was of 2.11/4, older Sliema residents still perceive Sliema as an ideal town to retire in.
The study concluded that the domain which ranked the highest age-friendly score was the social participation domain, followed by community and health services. Communication and information came in third place, followed by outdoor spaces, transportation and housing. The last two places with the least age-friendly scores were civic participation and employment in the seventh place, and respect and social inclusion in eighth place
The study showed that the concept of age-friendliness is a very complex one. Its complexity has to be seen in the light of two separate pillars.
Firstly, as has been argued throughout the study, age-friendly measures across the eight domains are interrelated and, therefore, should be tackled from a holistic point of view and not in individual interventions. Secondly, all the stakeholders need to work towards an age-friendly Sliema to achieve results.
The main stakeholders are the central government, which provides the services and resources for initiatives for age-friendly measures, and the local council, which is the link between the older persons and the central government.
As seen from the results, the parishes play a very important role in the everyday lives of senior residents in Sliema. While the local council is working hard on the physical infrastructure for its senior residents, the parishes should be targeting their resources not just as a solidarity output for the most vulnerable but targeting initiatives towards the senior citizens by being knowledgeable on the concept of age-friendliness and how this effects all the community.
The parishes underestimate the strength of the Church in working with other stakeholders in making a more age-friendly Sliema through its input in the social infrastructure. Thus, having a common body and, furthermore, a space where these initiative can be discussed and addressed would be the first milestone in promoting ageing in place and improving initiatives for a more age-friendly Sliema.
Finally providing a strong cross-national body will help to stimulate other communities to incorporate age-friendly measures. Promoting a dialogue between towns and villages across Malta, together with the different stakeholders, could drive the age-friendly agenda forward in a number of ways. It could provide knowledge of best practices scenarios, which would increase the understanding of initiatives that work and what does not work in particular policy areas. Different communities would be able to share methodologies and indicators to monitor and evaluate the wider socioeconomic impact of investing in innovative services for living environments.
As gerontologists, we should be focusing on being agents of change and focus on implementing changes towards age-friendly communities. As gerontologists, we believe that ageing is not lost youth but a new stage of opportunity and strength. We need to walk the talk in order to enhance partnerships among healthcare services and ageing services to help Maltese older persons thrive in their communities as they age.
Claudette Gauci is president of the Maltese Association of Gerontology and Geriatrics.