Ageing and urbanization: Can cities be designed to foster active ageing?

Abstract

The world is currently experiencing two major demographic transitions: the ageing of populations, particularly in low and middle income countries, and urbanization. This paper briefly summarizes current theories on how the urban environment may influence the health and quality of life of an older person, reviews epidemiologic studies that have investigated this relationship, and highlights urban initiatives that foster active and healthy ageing. The review identified an extensive body of research consistent with an association between the health of an older person and the physical, social and economic environment in which they live. However, most research in this field has been cross-sectional, and interpretation has been difficult due to numerous methodological limitations, particularly the risk of social selection biases. More recently, a growing number of longitudinal studies have identified associations consistent with previous cross-sectional research, adding weight to these findings. In the last two years alone, at least thirteen new longitudinal studies examining these issues have been reported, with ten having positive findings. Unfortunately, few of these studies can yet point to specific pathways that may be amenable to intervention. Concurrent with this research, a number of sizable programmes have been developed to make urban environments more supportive of older people. Both theory and the epidemiologic evidence appear to justify the optimism of these initiatives, although little evaluation has yet been undertaken of their impact.