Age-friendly environments: global trends and where is Central and Eastern Europe? EAST Workshop Budapest, June 2016 Zsuzsa Széman Maria Tróbert Semmelweis University

Demographic and urbanisation trends by 2050  WORLD % 65+22% Population of world in cities70% WHO, 2005, Global Age-friendly Cities -32 cities, Guide (2007)

Elder-friendly approach  environment,  social /welfare, societal follow up/ action, implemantation researches, secondary analysis proper urban planning e.g adequate urban environment financial sources experts/knowledge

East Canada, Quebec region 177 settlements Ottawa Pedestrian Signal Technology Snow Go Programmarket principle Snow Go Assistant Programsocial Low income/handicapped Snow Angelcivil /neighbours

Quebec region, Ottawa  Community Connect Training  Gatekeeper model  Isolated older people Mapping needs Listen to older people Fulfil needs  Social department of local government  Volunteers

Canada: West, British Columbia  :30 cities Vancouver: „Elder-friendly Action Plan ” (60+)  improve health state and well-being  decrease/eliminate social inequalities by action program  services for active and healthy  built environment  safety and emergency  education/training  Awareness  Elaborated by: seniors, carers, family carers of demented people, NGOs, local decision makers

Canada: Mid - Manibota region  Research: since late 90s  Centre on Aging, University of Manitoba new concept research on age-friendliness projects mapping elder-friendly plans  2013 more than 100 age-friendly settlements  1/3 below rural region

Manibota: age-friendly rural settlements Meaning and practice 1. Built environment and transport 2. Social participation 3. Information

1. Built environment and transport  Alteration E nvironment: e.g. set up public WC, obstacle-free public environment/public building, increase green areas, better lighting Involving market actors e.g. convince shop owners to let the public use the WC Transport logistics

2.Social participation a) whole community  e.g. recreation/health prevention for everybody,  parties,  social gatherings for all age groups, b) only for older age groups:  e.g. mapping older people at social risk,  visits,  drive training,  swimming training,  innovative projects by involving them

3. Information For whole community  social, health, cultural, services  safety  emergency Only for older generations  elder-friendly/current events

Main pillars of age-friendly environment  research  ICT development – long distances, bad weather  tertiary education  communication between different actors  volunteers, older people  financial support  good examples - widespread  focus: ageing society  aim to prevent social exclusion

USA Similar trends Similar tools Research E.g. University of Wisconsin, Institute on Ageing and Environment 2015: age-friendly − 24 states − 47 cities − New York City BUT Sun City 26% 65+  built for older people, different approach

Australia By % % (57% in 2002) Science/research + policy Elder-friendly environment  Urban  Isolated areas

To elaborate: HOW? Planning  whole community  older people  Tasmania  Positive Ageing Plan,  Positive Ageing Plan, 2012 – 2016

Pillars of Positive Ageing Plan 1. Health 2. Social 3. Community

Health  health state  financial situation  personal characteristics  gender  time spent alone

2. Social  family relations  social network  relations with carer

3. Community  social capital  information on social/community events  available services  improve services  allowance, benefit  improve access to transport  prevention of discrimination  tailored services  development of infrastructure

QUEENSLAND  big region  cooperation with Tasmania  adaptation of approach, good examples

Australia: Research Many researches from 2000s One result e.g. correlation between time spent away from home and subjective „being active” Source AirdSource Aird, Rosemary L - Buys, Laurie (2015): Active Aging: Exploration into Self-Ratings of "Being Active," Out-of-Home Physical Activity, and Participation among Older Australian Adults Living in Four Different Settings.Journal of aging research 2015 (9): BuysActive Aging: Exploration into Self-Ratings of "Being Active," Out-of-Home Physical Activity, and Participation among Older Australian Adults Living in Four Different Settings

Japan: age-friendly criteria 1971: city for the youth but old now Very rapid ageing city should follow, adapt to changes  physical  during lifetime  in life of family  in styles of generations  habits of generation

To achieve age-friendly environment  ageing-friendly planning,  decision making,  financing,  Research  development/ICT,  mobilisation of family resources

China  Mainland China  family role, special culture  ageing persons should remain with their family  Hong Kong  joint families - living together  Singapore  Planning 3 generations living together  China: special feature: different culture, role of family

India, Sri Lanka: age-friendly environment: different meaning  India, Delhi  poverty- poor infrastructure-crime police: mapping older people at risk, telephone register  Sri Lanka Cataracts - Eye Camps for Older People monks –temple- urge participation in screening New dimension of age-friendly environment: religion

Dublin Declaration on Age-Friendly Cities and Communities in Europe 2013  e.g. 10 European cities – research  Change of climate increasing morbidity (older people) o age friendly environment more green areas decrease negative trends. increase social cohesion, strengthen intergenerational and inner generational, community

Ireland 2008 e.g. Louth county program a great place to grow old 2013 national program, Age-friendly Ireland (15 cities) 2014 smaller towns as well: Cavan Age Friendly Town Initiative Age Friendly Cities & Counties Programme AIM: country where it is nice to be getting old.

Western, Northern Europe e.g. UK, Germany, Sweden, Finland, Netherlands similar trends

Central and Eastern Europe lagging behind EU initiative: „Q-AGEING (Q-AGEING - Quality Ageing in an Urban Environment) Slovenia, Maribor Italy, Treviso province, Genoa Poland, Sopot, Hungary, Budapest (XI district) Germany

Elder-friendly House Model (EF) AIM: Keep independence in home environment Co-operation NGO/ idea – ministerial financing Target group 75 +with home care recipients  Tailor-made obstacle-free home environment  different regions  different types of houses

Methodology Survey150 40% of falls – obstacles in the flat Subsample 50 Alteration 20 Follow-up 20 New sample 30

Help needed

Bathroom: problem 1 high bath, no grips

Bathroom: Solution 1 Shower tray, grips, moved washing machine

Bathroom: problem 2 High bath, obstacles

Bathroom: solution 2 Shower cabin, moved wash basin

Bathroom: problem 3, special Elderly owner insists on bath

Bathroom: solution 3, special Step and grips Felmérés:

Dissemination of model Tender – financed by ministry 2700 applicants ¼ approved Target group: older people over 65 + receiving social services

Spatial differences Potential for prevention of social exclusion Hungary: 19 counties 52% of applications from poorest 3 counties Northern Eastern (Szabolcs) 29% Northern (Borsod) 12% Eastern 11%.

Bielefelder Model (BM) 1996 aim: keep independent life - ensure social integration integrated service among LTC recipients Bielefeld region, 40 residential districts cooperation: emplamenting by 7 nursing services, 5 housing associations residential areas, 442 households

Characteristics I

Characteristics II

Bielefelder Model

Living space Service provider Establishment Alteration Adaptation Care- nursing Provider Personal needs Free choice Payment/fee based on need Authorities Munici- pality Community services Programs Volunteers

Similarities between the two models Aim: keep independence Obstacle-free environment Person-tailored care, alteration Regional Co-operation with others NGO –important role Roots of innovation: long history Intervention Social integration

Differences Elder-friendly House Bielefelder Model Safe home environment, preventing falls 65+ Households: 756 Home environment Financing: public Rural settlements Poor region Poor economic situation  Social integration Environment with complex care Other cohorts Households: 442 Special environment Financing: other sources

Present state of art  Social innovation in Central Europe  Catching up