Promoting respect and social inclusion for healthy ageing in the urban setting: a juxtaposition of research evidence, stakeholder perspectives and the views of older people.

Introduction: Population ageing and increasing urbanisation present challenges for public health policy and practice. Creating a supportive environment – as promoted by the WHO Age-Friendly Cities (AFCs) Initiative – is especially important for older people’s health. This thesis examines how views on strengthening respect and social inclusion in the urban setting differ among older people and city stakeholders, the extent to which their priorities are supported by evidence for health benefits, and the implications for public health policy. Methods: A systematic review was conducted of quantitative and qualitative evidence for the impact on health and wellbeing of interventions fostering respect and social inclusion in community-resident older adults. Photovoice was used to explore respect and social inclusion among 26 older people aged 60+ from four contrasting areas of Liverpool (UK). Perspectives on respect and social inclusion among 23 local policy makers and service providers were explored at interview. A photo-exhibition was then organised to generate meaningful discussions between the two groups. Synthesis compared findings for older people and city stakeholders, and assessed the extent to which priorities of both groups were supported by evidence from the systematic review. Results: Thirty-four quantitative evaluations included in the systematic review suggest that interventions on respect and social inclusion, particularly intergenerational and music and singing initiatives, may have an impact on psychological outcomes, wellbeing, subjective and physical health of older people. Fourteen qualitative studies identified some of the factors in the pathways to improved health outcomes (e.g. improved self-esteem and social relationships). Through photovoice methods, older people identified a wide range of enablers, barriers and potential solutions spanning services, the environment and city facilities. City stakeholders identified similar issues as older people, but were additionally concerned by impacts of budget cuts on provision and planning of respect and social inclusion. While some older people’s and city stakeholders’ priorities were supported by evidence (e.g. art and culture initiatives), there were no evaluations of the health/wellbeing impact of other important aspects for respect and social inclusion identified by older people and/or city stakeholders (e.g. attempts to promote affordability and accessibility of transportation). Discussion and Conclusions: Although city stakeholders appeared to understand many of the views of older people and vice versa, the former’s views were driven more by their need to address budgets constraints. Photovoice can be an effective tool to (i) engage older people, and (ii) incorporate their views into city planning. However, participants’ concerns about photographing difficult topics and producing ‘expected’ images need to be addressed. Future research should address previously neglected priorities identified by older people and city stakeholders. Systems thinking would help structure more inclusive evaluation of health impacts of AFC initiatives