Fit for purpose: Ageing cities

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Information about Fit for purpose: Ageing cities
Health & Medicine

Published on February 20, 2014

Author: Management-Thinking



Faced with increasing competition over the last decade, hospitals are having to be more flexible and efficient to survive. How can traditionally cash-strapped and risk-averse institutions incorporate new design ideas and improve the interaction between medical staff and patients? Designed for life: future-proofing hospital design is part of Fit for purpose, a series of articles sponsored by Philips on innovation in global health systems.

Ageing cities What are cities doing to make urban environments more age-friendly? M ore than half the world’s population lives in cities, and by 2030 three out of five individuals will be urban dwellers. At the same time, the share of the world’s population aged over 60 is rising rapidly. By 2050 people aged over 65 will outnumber children aged under 14, for the first time in human history. There is a growing recognition that if the needs of older people are properly recognised, this newly burgeoning population need not be a demographic catastrophe. The elderly can continue to be an important resource for families, communities and economies, but to make this happen, urban environments need to be more age-friendly. Eight years ago the World Health Organisation (WHO) launched an agefriendly cities project, based on responses to a survey of 1,500 older people living in 33 cities in 22 countries. This in turn led to a guide with a checklist of features that cities could use to assess their progress in improving life for older residents. It included provisions for adapted housing, employment, health services, transport, parks, social life and information services, as well as a discussion of older people’s concerns about how they are viewed and treated by their younger neighbours. The European Commission’s Innovation Partnership on Active and Healthy Ageing pilot scheme is making similar efforts to recognise and benchmark age-friendly projects in the cities of member states. These efforts include better urban planning, transport or housing schemes and e-healthcare, allowing people to access medical help and improving their opportunities for human contact, to prevent the scourge of loneliness which besets many elderly people. SPONSORED BY: Around the world, any number of innovations are being tested. Canada has come up with the notion of “pocket neighbourhoods” in cities such as Toronto, with shared open spaces between families and older neighbours to combat social isolation. Under the direction of its recently formed Elderly Advisory Council, the city of Barcelona in Spain has begun installing outdoor escalators to improve mobility and access, and the Finnish capital Helsinki has tested robots in the form of life-like baby harp seals responsive to touch and speech, which are intended as virtual pets to reduce the burden on urban care agencies looking after people with dementia. Chiayi City in Taiwan was among the first cities in Asia to embrace age-friendliness. Its municipal authority pioneered the concept of “health groceries”—neighbourhood centres for older people offering a lunch club, healthcare talks and check-ups, plus workshops and group activities. It is in Asia that the impact of global ageing is being most keenly felt. In 1950 there were 12 working-age people in Japan to support each pensioner. By 2025 that ratio will be just two to one. In China the one-child policy has caused a worsening crisis. Cities such as Beijing and Tianjin have the world’s smallest populations of children, with just 8% of residents aged under 14. In parallel, China has come up with proposals for more “universities of the third age” for the active, and more nursing homes for the frail, while South Korea has invested heavily in part-time public-sector employment programmes for people in their 70s, to stave off the multiple problems of poverty, loneliness and ill health. However, the city that is furthest ahead in terms of age-friendliness is probably New York, the home of Ruth Finkelstein, director of the WHO Collaborating Centre on Ageing, Globalisation and Urbanisation. Mrs Finkelstein, who is also senior vice-president for policy and planning at the New York Academy of Medicine, admits that earlier efforts to cater for old people in segregated retirement areas were often not appropriate. “The vast majority of people want to age where they live, stay in their own homes and do what they like,” she says. “We need to find out what the barriers are to them doing that and remove them, because the more we have people of all ages involved in our communities, the better it is for everyone.” To ensure that this happens, the city has embarked on a variety of measures in consultation with older residents. Many of the innovations are simple. Hundreds of benches have been installed with sectioned arm rests and space for shopping, so that frail elderly people have

somewhere to sit on their way out to buy food, without fear of being unable to lift a carrier bag from the ground or rise to a standing position. New transparent bus shelters including seats have been sponsored by advertisers, so that older users feel safe and can sit down. More than 1,000 corner shops have enjoyed a sales boost as a result of applying for an “age-friendly” designation and receiving folding seats. They also need to agree to offer regular glasses of water. Lists of age-friendly swimming pools with ramp access and colleges offering life-long learning opportunities have also been drawn up to improve social opportunities. New York is about to announce the winners of its first Age Smart Employer (ASE) awards, defined on the basis of perks such as flexible working, training and professional development for older people, and initiatives such as mutually beneficial mentoring. This might include a younger employee teaching an older one how to use new technologies, while older employees might explain to younger colleagues how to offer personal service and foster relationships with customers. The ASE awards are being funded by the Alfred P. Sloan Foundation, which was set up in 1934 by a former president of General Motors. Mr Sloan, who lived in an era when assembly-line workers retired at 60 and largely passed away soon afterwards, would no doubt be surprised to find that life expectancy is now two or three decades longer, and even more surprised to discover that people in their 70s are now actively seeking the social and intellectual stimulation of continuing work.

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