Table 1 Overview of environmental audit tools for healthy ageing in rural areas and low- and middle-income countries
Instrument | Setting | Data Collection | Components |
|---|---|---|---|
WHO Global Age-Friendly Cities Framework [12] | 33 cities located across Argentina, Australia, Brazil, Canada, China, Costa Rica, Germany, Ireland, Italy, India, Jamaica, Japan, Jordan, Kenya, Lebanon, Mexico, Puerto Rico, Pakistan, Russia, Switzerland, Turkey, United Kingdom, United States | Subjective reports from older adults, their caregivers, and service providers collected via focus groups | Outdoor spaces and buildings: aesthetics, natural spaces, safety, accessibility, pavement quality, toilets, seating Transportation: network connectivity, service frequency, priority seating/parking, sheltered stops/stations Housing: affordability, quality, maintenance, location near services and facilities Social participation: nearby community centres Respect and social inclusion Civic participation and employment Communication and information: universal written and broadcast media Community support and health services: healthcare providers, health promotion services, home care |
WHO Global Age-Friendly Cities Core Indicators [13] | 15 communities located across Argentina, Australia, China, France, India, Iran, Italy, Kenya, Russia, Spain, United Kingdom, United States | Objective data (SSO, administrative records, governmental statistics, expenditure reports, legal records) or subjective reports by older adults collected via surveys | Walkability: acceptable pedestrian paths or suitability for walking Public spaces and buildings: accessibility by wheelchairs or accessibility among those with mobility, vision, or hearing limitations Transportation: public transit with designated places or accessibility among those with mobility, vision, or hearing limitations; transit stops within 500-m walking distance or accessible Housing: affordability, based on < 30% of income or affordable neighbourhoods Inclusive social environment: older adult participation in cultural events and facilities or weekly participation in sociocultural activities Information: available information about health concerns and service referrals or knowing whom to contact about these matters Social and health services: formal home- or community-based personal-care services or having personal-care needs formally met within home or community |
Neighbourhood Design Characteristics Checklist [NeDeCC] [21] | England, across a “wide variety of rural–urban environments” | Objective systematic social observation (SSO) conducted by researchers based on an assessment of area within 300 m of older adult participants’ homes | Housing: type, form, height, age Street: type, shape, pedestrian-traffic segregation, topography, “eyes on the streets”, variety, block size, traffic level, setback Neighbourhood: urbanness, predominant block size, street network, intersection density, open space amount, land-use mix, density, “natural surveillance”, “legibility”, traffic, greenery amount |
Older People’s External Residential Assessment Tool [OPERAT] [22] | 405 postcode areas across Wales, “purposively selected for socio-economic and geographical diversity” | Objective systematic social observation (SSO) conducted by a sole researcher walking through each postcode area; initial set of measures refined via a qualitative thematic analysis of feedback from a 15-member expert advisory group and a set of weights derived from questionnaires distributed to 13 forums of ages 50-plus in Wales | Natural elements: public grasses or verges, sounds of nature, private tree density Incivilities and nuisance: traffic, industrial, or other loud noises, litter/waste/broken glass, traffic level Navigation and mobility: road-sign legibility, street and alley lighting, sidewalk/footpath quality, road quality Territorial functioning: building and garden maintenance, parking, industrial nature of main street |
WHO Age-Friendly Cities Indicators in informal settlements [15] | Korogocho and Viwandani, two informal settlements in Nairobi, Kenya | Objective data derived from surveys (Nairobi Health and Demographic Surveillance System and Urbanization, Poverty, and Health Dynamics) and from SSO carried out by researchers; subjective reports by older adults drawn from focus groups | Walkability: acceptable pedestrian paths Public spaces and buildings: new and existing public spaces accessible by wheelchair Transportation: public transit with designated places for older people or people with disabilities Housing: affordability, based on < 30% of income Inclusive social environment: monthly or twice-monthly attendance at group, club, society, union, or organization or at-least weekly attendance at religious services Information/Social and health services: lack of access to healthcare when needed over past year |
China Health and Retirement Longitudinal Study [CHARLS] age-friendly criteria [14] | 301 rural villages and 152 urban communities across China | Objective SSO data collected by researchers and subjective reports drawn from face-to-face interviews with local officials | Outdoor spaces and buildings: topography, road types/quality/cleanliness, public toilets, pollution, road network/cleanliness, construction types, crowds, accessibility Transportation: bus lines, distance to bus stops, distance to train stations Housing: residential-lot size, community central heating, sewer system, affordability Social participation: presence of public exercise facilities/support organizations/arts organizations/activity centres Communication and information: telephones, cell phones, TVs Community support and health services: presence and distance to public facilities, community centre presence/services/usage/costs |
WHO Study of Global AGEing and Adult Health (WHO-SAGE) built environment index [23] | 42 districts across South Africa | Objective healthcare data drawn from the District Health Barometer and subjective reports from South African General Household Survey respondents | Housing: housing, water, sanitation, electricity Community support and health services: nurse clinical workload in primary healthcare facilities |
Environmental Profile of a Community’s Health [EPOCH] 1 [19] | 652 urban and rural communities in Argentina, Brazil, Canada, Chile, China, Colombia, India, Iran, Kazakhstan, Malaysia, Pakistan, Palestine, Philippines, Poland, Russia, Saudi Arabia, South Africa, Sweden, Tanzania, Turkey, United Arab Emirates, Zimbabwe | Objective systematic social observation (SSO) conducted by researchers during a one-kilometre walk around each community’s centre | Outdoor spaces and buildings: sidewalk completeness and quality, presence of street trees and flowerbeds, access to public parks and recreational areas, number of public places for recreation/physical activity, road completeness and quality, street lighting, traffic lights Transportation: availability and frequency of bus and train connections to other towns, access to train stations Housing: cost of residential land, cost of housing Civic participation and employment: access to government buildings Community support and health services: access to hospitals, access to public and private medical clinics |
Environmental Profile of a Community’s Health [EPOCH] 2 [18] | 605 urban and rural communities in Argentina, Brazil, Canada, Chile, China, Colombia, India, Iran, Malaysia, Pakistan, Philippines, Poland, Russia, Saudi Arabia, South Africa, Sweden, Tanzania, Turkey, United Arab Emirates, Zimbabwe | Subjective reports by study participants, aged 35–93 | Social participation: community social cohesion Communication and information: internet access at home, free public internet access |