Viewpoints of Elderly People on Components of Age-Friendly Cities: A Cross Sectional Study

Extended Abstract
Background

It is essential to build the required infrastructures for an age-friendly community in Iran, which will soon experience population aging. Health professionals, especially community health nurses, can play an effective role in developing age-friendly communities through evaluating the current situation and identifying its strengths and weaknesses. However, few studies have been conducted in Iran on the indicators of an age-friendly city identified by nurses as the major professional health care providers. Given the fact that the components of social respect, inclusion, participation, and communication are all related to psychosocial dimensions of health, and the components of cultural offers, entertainment, and health care are closely related to physical, social, psychological, and spiritual dimensions of health, the present study aimed to represent the views of elderly people regarding the status of four health-related domains of age-friendly cities in Tabriz, Iran.

Methods

This descriptive-analytic study was conducted using a cross-sectional design. The statistical population included all the elderly from six age-friendly centers (Shahid Mon'em Pour, Malek Afzali, Vali'asr, Sa'di, Mobin, and Ibn-e Sina) in Tabriz, the capital city of East Azerbaijan Province in Iran. Using simple random sampling method, we selected a total of 351 older adults. Inclusion criteria were absence of psychological and cognitive disorders, no severe visual impairment, and willingness to participate in the study. Data were collected using the short form of the Abbreviated Mental Test (AMT), a demographic checklist, and Age-Friendly Environment Assessment Tool (AFEAT). Demographic profile included age, gender, education, housing, type of insurance, and adequacy of income. The AMT is the most widely used cognitive screening test for older adults consisting of 10 items scored as true/false responses; those who score 7 and higher can enter the study. The World Health Organization (WHO) age-friendly cities framework proposes eight domains. In this study, four health-related domains, including social respect and inclusion (12 items), social participation and communication (8 items), health care (13 items), and cultural offers and entertainment (18 items) were investigated. The AFEAT is based on a 5-point Likert scale (Strongly Disagree =1; Disagree =2; Neutral =3; Agree =4; Strongly Agree =5). Scoring was done based on the mean score of participants’ responses. To test the reliability of the tool, internal consistency and Cronbach's alpha were used. Cronbach's alpha coefficient was calculated for the domains of age-friendly cities, which was 0.86 for social participation and communication, 0.80 for social respect, 0.82 for healthcare services, 0.86 for cultural offers and entertainment, and 0.92 for the whole scale. Descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (analysis of variance) were utilized to analyze the data using the Statistical Package for the Social Sciences (SPSS) software version 16 at a significance level of 0.05.

Results

Of 351 participants, 62.1% were female. The majority of participants (78.91%) were in the age range of 65-75 years. Furthermore, the education level of 1.6% was high school or lower, 74.9% were married, 87.7% owned a personal house, and 65.8% reported adequacy of income. Among the four domains, the health care domain had the highest mean (44.57 ±11.81), followed by social respect (38.5 ±11.5), social participation and communication (34.8 ±9.12), and the cultural offers and entertainment (32.86 ±10.54). Among health care items, while the item "health care staff and consultants received the required trainings on elderly health" obtained the highest positive responses, the item "health services such as physical therapy, canes, glasses, and hearing aids are properly distributed among older adults" obtained the highest negative responses. In terms of social respect, while the item "there are places dedicated to providing public training on senior hood" received the highest positive responses, the item "priority seats have been designated in public transport vehicles" received the highest negative responses. Regarding social participation and communication, while the item "there are training courses with topics of interest to the elderly such as the Internet and computer, chess training, Qur'an teaching, etc." received the highest positive responses, the item "large or capital letters are used in electronic devices such as ATMs, payphones etc." obtained the highest negative responses. Among the items related to cultural offers and entertainment, while the item "volunteers were attracted from health centers to develop programs for older adults' health" received the highest positive responses, the item "books, journals, and CDs are home delivered for older adults" obtained the highest negative responses. Regarding the relationship between health-friendly components and contextual variables, a significant correlation was found between gender and marriage with cultural offers and entertainment domain (P = 0.02, P = 0.002).

Conclusion

Since none of the four indicators of age-friendly cities in Tabriz were standard, the managers of aging-related organizations should plan to standardize these indicators to achieve the desired conditions. Here, the following measures are recommended: culture building, training families, handing over cooperative sectors to volunteer seniors, planning for older adults' leisure activities, establishing in-home care services, and paying more attention to the key role of health professionals (e.g., nurses).