Age-Friendly Environments and the Well-Being of Older Adults

Background and Purpose: The concept of age-friendly communities (AFC) was created to promote living environments that contribute to better health and well-being of older adults. There has been limited research examining the effects of AFCs on the well-being of older adults and existing research has produced mixed results on which aspects of AFC are related to well-being. With the growth of AFC initiatives in the US and worldwide, objective measures are needed that can be used across different samples and geographic locations to evaluate the effectiveness of these initiatives. The AARP’s Livability Index provides information about how livable a community is for older adults. This has been used in prior research and is a popular tool to guide individuals and communities, but it has yet to be examined with well-being outcomes across geographic regions. The purpose of this study is to examine if older adults living in more livable communities have better health.

Methods: We used data from the 2017 AARP AFC Surveys that sampled 6,670 adults in 14 U.S. metropolitan areas using telephone interviews in 2017. To include zip code–level livability indices, we merged AARP AFC Surveys with the AARP Livability Index. This study included 2,570 adults aged 65 and older across 262 zip code areas for our analyses. The average age was 75 years (SD=7.7) and 55% were female. The majority of older adults were non-Hispanic White (78%), followed by Hispanic (12.1%), Black (7.3%), Asian (1.3%), and other races (1.3%).

We used self-rated health as the outcome variable (M=3.44; SD=1.11; range: 1-5). We included seven livability index scores: housing (affordability and access), neighborhood (access to life, work, and play), transportation (safe and convenient options), environment (clean air and water), health (prevention, access to health care, and quality of health care), engagement (civic and social involvement), and opportunity (inclusion and possibilities). The indices range from 0 to 100 and higher scores indicate a better neighborhood condition. Adjusting for individual characteristics, we ran two separate multiple regression analyses to examine whether older adults living in a livable community have better self-rated health using a total livability score by communities and whether each livability index is associated with self-rated health.

Results: The first analysis found that older adults who lived in a livable community had better self-rated health (b=0.01, SE=.01, p=.048). The second analysis showed that those living in a community with accessible and quality health care had better self-rated health (b=0.01, SE=.003, p=.027). However, other livability indices were not associated with self-rated health. In addition, higher income, employment, and frequent social contact were associated with better self-rated health. Compared to non-Hispanic White, Black older adults had worse self-rated health, whereas Pacific Islanders had better health status.

Conclusions and Implications: This study adds to the growing literature on the role of age-friendly environments on the well-being of older adults. Since access to and quality of health care can improve the self-rated health of older adults, social work practitioners and policy-makers should work to improve their health care services and accessibility.