With its dizzying skyline and unforgiving taxi-drivers, New York City might not strike you as the ideal place to grow old gracefully. Nevertheless, last month the city’s mayor, Michael Bloomberg, picked up a certificate declaring it to be the first member of a global network of age-friendly cities.
The World Health Organisation (WHO), whose initiative the network is, wants the people who run the world’s cities to think more deeply about the needs of ‘silver citizens’. The world’s greatest cities were usually planned by, and for, able-bodied men. But society is changing. As people live longer, more and more city-dwellers are negotiating the urban environment while coping with some degree of physical or mental impairment.
“Whether somebody is disabled or not depends on two things: their physical capacity and the environment they live in,” says John Beard, director of the WHO’s Department of Ageing and Life Course, who is based in Geneva, Switzerland. It may be unrealistic to expect cities to change their existing infrastructure, but he believes that with good planning and age-conscious prioritisation of investment, the quality of life of the elderly can be improved immensely.
A whole new academic field, environmental gerontology, aims to identify how that can be achieved. Old age is a time when people become profoundly vulnerable to their environment. A visually impaired person, or a person who cannot climb into a bus, is immediately restricted in his or her movements in a city, for example. But many of the problems that such people experience may also be experienced by younger, healthier people. “Pedestrian crossings are made for Olympic runners,” one elderly Canadian reported in a WHO survey – a sentiment with which wheelchair users and mothers of young children might concur. As Beard says, everyone stands to benefit from age-friendly cities.
The Big Apple is far from being fully age-friendly yet, he says, but it is a long way ahead of many other cities, including London. It has already begun to tackle, for example, two of the main obstacles elderly city-dwellers report: a shortage of public seating and a shortage of lavatories.
In New York City, now, you can see flip-down seating on the sides of buildings, and businesses are being encouraged to make their toilet facilities available to elderly passers-by. “Neither of those requires significant investment,” he says, but it means, notably, that elderly people are more likely to venture further from home.
Other issues may require more investment. The New York authorities have identified black spots for pedestrian accidents in areas with large elderly populations; causes include fast-moving traffic and uneven paving. Better pavement maintenance will benefit everyone, but won’t slow traffic; and increasing pedestrian crossing times penalises other sectors of the population, including the economically productive. It’s a question of priorities, says Beard. “Are you giving priority to the people who are trying to get to the other side of the city in a car, or are you giving it to the people who are shopping, walking and actually living in those areas?” he says.
Planning authorities have to take into account the increasing economic importance of the ‘grey pound’, spent by the over-fifties as consumers. Moreover, elderly people represent a significant burden on healthcare and social services resources, so it makes sense to keep them healthy and independent for as long as possible.
Initiatives with that goal in mind are springing up everywhere, and among the most popular is the lifetime home: the home designed for life from the cradle to the grave, with, for example, level access to the main entrance and a lavatory on the ground floor. In London, all new social housing must now meet such criteria, and that target is likely to be extended countrywide next year. Some property developers object to the costs, which the government estimates will amount to £500 per house, but the charity Age UK believes it will work out cheaper than “retrofitting” – adapting homes later on. “Over 20 years, an age-friendly home can make substantial savings on adaptation costs and, ultimately, NHS and social care costs too, as it will prevent people from moving into residential care or hospital,” says Age UK spokesman Stefano Gelmini.
People with dementia have more complex and subtle deficits. Impairments of memory and spatial orientation can make it difficult for them to find their way around, says Gordon Wilcock, an expert in Alzheimer’s disease at the University of Oxford, but their procedural memory, or memory for learned routines, is often preserved.
This means that removing them from a familiar environment can be more detrimental than leaving them in one which may not be perfectly adapted to their needs. The solution is to make those environments dementia-friendly. Research by architect Lynne Mitchell and colleagues at Oxford Brookes University suggests people with dementia rely on familiar landmarks or “street furniture”, such as red pillar boxes, to orient themselves. Excessive signage or changes in texture at ground level can confuse them, as can long, straight homogeneous streets. Having shops and other facilities grouped together can be helpful, preventing them from wandering and getting lost. In fact, says Wilcock, “the city can be a good place for people with Alzheimer’s”.
At the Bath Institute of Medical Engineering, Tim Adlam and colleagues are evaluating smart housing for people with dementia. Features include movement sensors, automatic lighting and pill dispensers, and verbal prompts. Not only have carers reported that such living arrangements reduce their work load, says Adlam, but smart houses offer greater insight into the health problems of their occupants. One man with advanced dementia was able to live alone in such a flat for the last year of his life; the information fed back from the sensors revealed that his sleep was very disturbed – a problem his carers had not previously identified.
Benyamin Schwarz, an architect at the University of Missouri who edits the Journal of Housing for the Elderly, is not convinced cities can cater for all disabilities. Inevitably, he says, there will be conflicts between groups with different needs. Some elderly respondents to the WHO survey reported that tactile flooring designed to help blind people orient themselves at road junctions can be difficult to walk on, for example. “Every one of us ages in different ways,” says Schwarz.
No condition illustrates the random, and often highly selective, nature of decline better than a stroke, which can affect almost any brain function. One stroke victim might lose the ability to read signs, while another may experience partial paralysis or balance problems.
Yet Ana Palazon, a spokesperson for the Stroke Association, believes there are certain general principles, such as making entrances wide, that will benefit everyone. A recent movement in favour of ‘universal design’ aims to gather such principles into a set of good practices for architects designing for lifetime living.
In the end, that is all the WHO is asking for. And Beard says that even the world’s poorest cities can factor in age-friendly features such as communal meeting places. By creating spaces where the generations can mix, some of the unhelpful stereotypes that cause segregationcan be broken down. Young people find out that the elderly aren’t useless; the elderly learn to be less afraid of “hoodies”. “Society has tended to marginalise the old and infirm,” says Beard. “What we’re talking about is creating an environment that allows them to continue to participate.”
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