Multiple theories from the psychological and occupational therapy sciences suggest that there may be reciprocity between activity selection and the meanings we draw from them. As such, meaningfulness may be an important contextual mechanism through which activity engagement positively influences cognition, but no research has examined these links in healthy middle-aged and older adults. This study examined the predictive ordering of the associations between activity engagement, meaningfulness, and cognition. Eighty-one individuals aged 41-94 years old completed questionnaires on activity participation, engagement in meaningful activities, and a range of cognitive tests. Structural equation modeling controlling for age and education was used to test multiple mediation pathways linking activity and meaningfulness to cognition. There was a significant positive direct effect of meaningfulness on activity, where individuals who had higher ratings of meaningfulness also engaged more frequently in activity. However, neither activity nor meaningfulness significantly mediated the pathway to cognition, and direct effects between activity engagement with cognition and meaningfulness with cognition were unexpectedly not significant. Correlational results showed the strongest connection occurred between social activity and meaningfulness, highlighting domain specific effects, and suggesting that social health, a key part of successful aging, is linked to the perceived value of an activity. It remains possible that the links between activity, meaningfulness, and cognition may exist longitudinally or at the daily level.
Aging is defined as the accumulation of damage, and several factors have been recognized as “factors of aging”. A sensible holistic approach is appropriate to reduce the rate of accumulation of damage, while maintaining the well-being of the individual. The holistic approach of L-Raphael defines seven fields of intervention: Outdoor management, Physical management, Medical management, Nutritional management, Stress management, Aesthetic management, and Leisure management. These interventions apply to skin aging as well. Perhaps all of the known factors of skin aging induce the synthesis of intercellular adhesion molecule 1 (I-CAM 1) in endothelial cells. I-CAM 1 molecules bind circulating immune cells, who then exit the blood vessels, enter the dermis, and initiate an inflammatory process, which entails three oxidative bursts and the release of proteolytic enzymes. The micro-inflammatory theory of skin aging describes the different factors that accelerate the rate of aging and recommends biochemical interventions. These biochemical interventions fit the seven holistic managements quoted above. The principal factor of skin aging is known to be solar exposure, which generates DNA damage that triggers an inflammatory reaction. Hence the importance of Outdoor management that recommends protecting against UV and using boosters of DNA repair such as Nicotinamide. Anoxia associated with stationary standing positions induces the synthesis of I-CAM and consequently of varicose veins and of spider veins. Well-managed physical exercise is therefore recommended to avoid the onset of anoxia. Medical management of cutaneous hygiene helps avoid the damage provoked by the response to local infections. Tailored targeting of the skin microbiome might be an additional tool in that sense. Glycated proteins induce I-CAM 1. The skin of people with diabetes is particularly affected, and nutrition management could avoid favoring conditions that facilitate protein glycation. Psychological stress provokes the release of I-CAM 1-inducing neuropeptides in the skin. Stress management is very important to maintain skin inflammation-free. The aesthetics of the skin suffer because of tobacco smoking. This is especially true when the skin is exposed to UV. Tobacco smoke is vasoconstrictive and reduces nutrient supply to the skin. Undernourished cells undergo necrosis and trigger inflammatory responses. Leisure management and balanced time use are crucial. Sleep deprivation does negatively affect skin health, and sleep is a necessary condition for global well-being.
The editors of OBM Geriatrics would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2025. We greatly appreciate the contribution of expert reviewers, which is crucial to the journal's editorial process. We aim to recognize reviewer contributions through several mechanisms, of which the annual publication of reviewer names is one. Reviewers can download a certificate of recognition directly from our submission system. Additionally, reviewers can sign up to the Web of Science Reviewer Recognition Service (formerly Publons) (https://webofscience.com/wos/) to receive recognition. Of course, in these initiatives we are careful not to compromise reviewer confidentiality. Many reviewers see their work as a voluntary and often unseen part of their role as researchers. We are grateful for the time reviewers donate to our journals and the contribution they make.
Driving is a complex cognitive behavior that is an essential part of everyday life and can be broken down into many subcomponents. Due to aging and medication interactions, a wide range of motor, sensory, and cognitive skills that are imperative for driving are affected in older adults. Several studies show that the number of crashes and mortality rates increase by age and the consumption of cannabis and cocaine is associated with a range of adverse mental and physical effects. The purpose of this study was to identify driving-related cognitive-performance differences associated with aging in older adults, and recreational drug use in younger adults. Data from a control group of healthy non-drug impaired younger (Control Younger (n = 278, f = 186, m = 90, other = 2, 19.89 ± 5.36)) and older adults (Control Older (n = 47, f = 22, m = 25, other = 0, 66.06 ± 6.85)) was collected. We also recruited over 300 participants, primarily frequent drug users who tested positive for various drugs including cannabis (Cannabis (n = 114, f = 19, m = 95, other = 0, 37.41 ± 11.69)) and/or cocaine (Cannabis/Cocaine (n = 162, f = 24, m = 137, other = 1, 47.99 ± 12.94)), (Cocaine (n = 60, f = 13, m = 47, other = 0, 52.45 ± 7.86)), on a urine test. Frequent drug users exhibited significant cognitive deficits compared to older adults and control groups, particularly in memory and decision-making domains. Cannabis users performed less accurately in memory tasks than older controls age 65 and older. Polysubstance users (concurrently using cannabis and cocaine) demonstrated the poorest performance, outperformed by younger controls in all measures and showing significant reaction time impairment compared to cannabis users. Older adults seem to perform similar to younger adults when age is controlled for. Our findings indicate that frequent drug users exhibit significant cognitive deficits in memory and decision-making domains, which can impact driving-related performance. These deficits are pronounced compared to both older and younger control groups, highlighting the potential risks associated with drug use and driving.
The sexuality of older adults at advanced stages of illness, or at the end of life, remains a taboo topic that is rarely addressed in the literature and in practice. As a result, the knowledge base informing the support needs of older adults at the final stages of life with regards to sexuality remains scant. The present study seeks to explore experiences of sexuality in older adults with serious illness or receiving palliative care, focusing specifically on the place of sexuality in their lives, the forms of sexuality expressed, and the challenges this population may face regarding their sexuality. The study is based on an interpretive qualitative design and relies on individual semi-structured interviews conducted with 10 older adults, between the ages of 69 and 86, who were receiving services from a palliative care program. The interpretive analysis of transcribed data generated two divergent themes that appeared to represent participants’ overall experiences with sexuality: “Sexuality excluded from life” and “Intimacy and sexuality integral to life”. While the analysis suggests that a distancing from sexuality can occur at advanced and terminal stages of incurable illness, it also suggests that sexuality does remain an important part of life for some older adults at advanced stages of a condition. The analysis further revealed a diversity of sexual expression which included, intimacy, genital sexual practices, and sexual thoughts and fantasies. The study contributes to the deconstruction of ageist and ableist biases by contesting the desexualization of older adults at the terminal stage of illness or at the end of life. The findings highlight the importance of acknowledging and addressing the sexuality of older adults in palliative care settings and in research.
The complex process of skin aging results in noticeable changes, including decreased collagen content, reduced elasticity, and decreased hydration. Interventions to preserve or restore collagen, a key structural protein, may help counteract these signs. The concept of "beauty from within” through nutritional supplements is of growing interest, particularly the use of plant-based alternatives to animal-derived or synthetic collagen. This study investigated the anti-aging potential of an extract from Moldavian dragonhead (Dracocephalum moldavica L.), a natural plant-based compound. In vitro studies have shown that the extract stimulates genes crucial for skin structure. Further, a double-masked, randomized, placebo-controlled clinical trial in female volunteers demonstrated that oral supplementation with the extract significantly improves skin hydration and increases dermal and full-skin thickness. These findings suggest that the Moldavian dragonhead extract is a promising natural alternative to traditional interventions, offering a holistic approach to improve the skin's dermal network and combat skin aging.
Aging is a multifaceted journey shaped by diverse life-course experiences, which contribute both to the challenges populations face in achieving their health goals and to the competencies they can bring to sustain health and aging. Community strategies designed to support population health—by leveraging technology and external partners—require transformation to effectively extend their focus to aging-related goals. In this paper, we adopt a service lens to examine how these community strategies, which co-produce practices and services, can be adapted to leverage population competencies. Drawing on social diagnosis research, we categorize key challenges and competencies and present four case scenarios that illustrate how advanced technologies can be leveraged to transition community strategies to support aging goals. The paper concludes by exploring how populations can actively design their own aging pathways and offers suggestions for future research.
Falls are a serious global public health issue affecting individuals of all ages, resulting in serious injuries, fatalities, and extended hospital stays. While knowledge and attitude of healthcare staff toward fall prevention are understood to impact patient safety, less well known are the type and content of fall prevention surveys used to identify nurses’ knowledge of fall prevention. Until now, no study has systematically reviewed the universe of existing tests, surveys, and programs used to assess fall prevention knowledge. This systematic review aims to describe existing tests and surveys used to assess the knowledge and attitudes of healthcare staff and nurses regarding fall prevention. Electronic databases PubMed, CINAHL, Scopus, Medline, ScienceDirect, and Psych Info were searched for English articles investigating existing surveys and tests of fall prevention knowledge among healthcare staff from 2005 to August 2024, focusing on studies in healthcare workers working in medical centers, working with adults >65 y.o. Of the 565 studies identified, twelve met the inclusion criteria: eight examined fall prevention knowledge, attitude, self-efficacy tests, and questionnaires among nurses and nursing students, and four examined fall prevention knowledge programs. One study examined the efficacy of a fall prevention program. Across all studies, various types of knowledge/self-efficacy questionnaires were utilized with overlapping content on fall definition, information on falls, teamwork, and reporting falls. Also, the educational studies suggested the importance of using fall prevention programs which include various components: online and in-person lectures, posters, and staff support, highlighting the need for continuous training rather than once for improved results. Overall, understanding the knowledge and attitudes of healthcare staff, especially nurses, toward fall prevention is crucial for improving patient safety and reducing adverse events in healthcare settings. Future research should include an assessment tool that considers all the components of behavioral change and captures all overlapping questions in one questionnaire, as well as including them in frequent training.
Evidence shows the use of interventions to prevent falls are costly to healthcare facilities. Using a sample of older adult patients who fell at least once during the intervention year of a three-year cohort study in one long term care nursing facility, at a continuing care community providing skilled nursing and assisted living, we provide detailed evidence of the number and costs of durable medical equipment and number and type of non- durable medical nursing care interventions utilized to prevent subsequent falls. This level of description can aid healthcare facilities and administrators in their plans to reduce recurrent falls among older adults.
Senior centers serve as community anchors for the approximately 57.8 million older adults in the U.S., offering a range of health promotion programs, including exercise classes. This study examined how the type of exercise programs at senior centers influences older adults’ health (mental, physical, and quality of life) and how baseline physical activity levels may influence these changes as part of a statewide health promotion program evaluation in senior centers in Delaware. The exercise programs offered were based on each senior center’s needs, increasing the feasibility and accessibility of these classes. Data was categorized by type of exercise class attended, “aerobic” (n = 63), “muscular strengthening” (n = 44), “balance and flexibility” (n = 20), or mixed class type participation (n = 13). Participants (n = 141; age: 74.4 ± 8.1 yrs; 87.1% female) attended exercise classes at their respective senior centers across the state of Delaware. Participants completed pre-and post-program assessments of perceived mental and physical health, quality of life, and physical activity level. Participants’ baseline physical activity levels were “Inactive” (n = 54), “Moderately Active” (n = 24), or “Active” (n = 45). A linear regression model was used to examine whether health outcomes were predicted by the type of exercise class and baseline physical activity level. Class type, baseline physical activity levels, age, and sex did not significantly predict post-program perceived physical and mental health or quality of life. However, pre-program scores of physical health, mental health, and quality of life significantly predicted their associated post-program health outcome scores. Overall, regardless of exercise class type, age, sex, or pre-participation physical activity, senior center exercise classes positively impact mental health and quality of life amongst older adults. These findings indicate that senior center exercise programs may be a cost-effective public health strategy to support healthy aging, by improving older adults’ mental health and quality of life.
Older adults are a growing population characterized by a high prevalence of multimorbidity and age-related conditions, such as organ and pharmacokinetic dysfunction. Medical digital technologies have emerged through the combined use of wearable, implantable, and insertable medical devices with digital systems. Gerontology aims to help older patients with disabilities utilize these technologies. These technologies are used in high-tech medical centers, particularly among older cardiac patients. Many cardiac societies support these technologies because of their positive medical effects in older cardiac patients. These technologies are added tools to support better outcomes and experiences of care in older cardiac patients. Medical centers claim that these technologies might enhance patient care, improve health outcomes, and lower medical expenditures. There are, however, some drawbacks. Internet technologies cannot completely replace face-to-face contact among cardiologists and patients. It is too early to assume that these technologies can be adopted without some adverse effects on the outcomes among high-risk cardiac patients with multimorbidity. Furthermore, it remains to be proven that such technologies can currently lower health costs, and one should also consider the significant expenses associated with their effective utilization. Furthermore, most health insurance plans do not cover bills resulting from these technologies. Therefore, family physicians show little interest in these technologies. The purpose of our mini review is to summarize the achievements of available medical digital technologies in geriatric cardiology and outline their drawbacks.
Telomeres are repetitive structures at the ends of linear chromosomes. Due to incomplete DNA replication at the end of linear DNA molecules, the so called “end replication problem”, telomeres shorten consecutively during cell division. In addition, telomere sequences are highly susceptible to oxidative stress damaging telomeres and resulting in their dysfunction even in non-dividing cells. Telomere shortening has been identified as one of the underlying causes for replicative senescence that can also contribute to aging due to the accumulation of senescent cells with advanced age in various tissues. These cells, in addition to an irreversible cell cycle arrest, are also characterized by a specific senescence-associated secretory phenotype (SASP) and hence increased inflammation. However, also postmitotic cells that do not shorten telomeres can have damaged and dysfunctional telomeres, undergo senescence without a specific cycle arrest and have a SASP. The influence of senescence on the aging process can be partially reversed by removing senescent cells from the body using senolytic agents. Many studies related to this topic, analyze predominantly blood leukocyte telomere length and suggest a direct causal relationship between telomeres, aging and diseases. Importantly, it is now more and more accepted that telomere length has a strong genetic element that is already obvious in newborns and might determine the trajectory of telomere dynamics through the entire adult life and thus pre-determine lifespan, aging and the susceptibility to various ageing-associated diseases. Moreover, there are additional factors such as oxidative stress and inflammation as well as lifestyle interventions that are able to influence telomere length (TL) and telomere shortening rate (TSR) during an individual’s lifetime. The review aims to raise awareness of the different factors that impact telomeres for a better understanding of the intricate relationship between telomeres, senescence, aging and age-related diseases.
Age-related decline in swallowing function increases the risk of dysphagia in older adults. Strengthening the muscles involved in swallowing through proactive training may help prevent such decline, particularly in prefrail individuals. This case series evaluated the feasibility and physiological effects of a home-based effortful swallow training program in three prefrail older adults without swallowing impairments. The intervention used a wearable surface electromyography biofeedback device (Mobili-T®) to provide real-time visual feedback on submental muscle activation during effortful swallows. Participants completed six weeks of training at home, five sessions per week, and underwent pre- and post-intervention assessments of tongue pressure and submental muscle activity during regular and effortful swallows across various consistencies. All participants completed the program with high adherence (above 94%). Two participants demonstrated improvements in tongue strength that exceeded minimal detectable change thresholds, while two showed at least 50% increases in submental muscle activity, indicating neuromuscular adaptation. Participants reported positive experiences with the usability and structure of the program. However, perceived functional improvements were limited, consistent with the preventive focus of the intervention. These findings suggest that home-based effortful swallow training supported by real-time biofeedback is feasible and well tolerated in prefrail older adults, with potential for individualized neuromuscular gains. Further research is needed to optimize training parameters, assess long-term effects, and determine whether such programs can reduce future dysphagia risk.
The shrinkage of muscles with age, beginning at 30 y and accelerating in old age, is due largely to atrophy of fast-twitch muscle fibers (FT) partly from disuse. It was our purpose to develop an exercise program that is effective and time efficient at stimulating FT, as well as slow-twitch fibers (ST), to offset their atrophy. FT are recruited during movements requiring very high force and/or high velocity. We developed a safe exercise cycle that allows a person to ‘accelerate’ with the maximal effort needed to recruit the highest number of ST and especially FT fibers. ‘Inertial Loading’ allows the person to maximally accelerate the cycle flywheel through the full range of the force vs. velocity relationship (0-160 RPM), and accurately identifies maximal power (Pmax), which can be used to diagnosis muscle loss. Of note, Pmax is usually five-fold higher than the power encountered during any aerobic exercise or ‘High Intensity Interval Training (HIIT)’. The very high Pmax serves as a very potent stimulator of the muscle, the nervous system and the cardiovascular system. This remarkably reduces the total exercise time (1-2 minutes) needed in a 10-minute workout, which is comprised of repeated 4-second accelerations and 15-45 seconds of recovery. The 4-seconds of maximal acceleration robustly activate FT, based on increases in mRNA from genes and pathways involved in muscle hypertrophy. Furthermore, NASA experiments used these cycle accelerations during 70 days of bed rest, that simulates muscle atrophy with space flight but also aging. NASA reported that performing 24 seconds (4 s × 6) of maximal acceleration cycling every 8 days, along with less frequent short bouts of aerobic exercise, totally prevented the normally large atrophy of FT, and it reduced the whole muscle atrophy by one-half. Specifically, when older adults train with maximal accelerations for 8 weeks, they display significant hypertrophy of their thigh muscles, increases in maximal power, and better performance in tasks of daily living. The cardiovascular system also improves function with these repeated high-power sprints and short rest, with significant increases in heart function, maximal oxygen consumption and arterial elasticity. Therefore, performing repeated maximal 4-second accelerations on an inertially loaded cycle ergometer, beginning at 30 y and continuing throughout old age, has promise to be a safe and viable proactive treatment to both diagnosis and counteract the progression of muscle wasting, sarcopenia and reduced cardiovascular function.
There is a main difference between theories explaining aging as an adaptive phenomenon that is determined and modulated by genes (i.e., the result of a specific “program”) and theories explaining aging as a non-adaptive phenomenon caused by the accumulation of random degenerative events. In fact, for adaptive theories, a genetically determined and modulated program determining aging is indispensable, while for non-adaptive theories, such a program cannot exist. However, there appears to be strong evidence to support the existence of this program as proposed by the subtelomere-telomere (STT) theory with the action of TERRA sequences. The STT theory with TERRA sequences was developed in four successive phases: 1) Aging caused by limitations in cell duplication; 2) Aging caused by progressive telomere shortening; 3) Aging caused by progressive inhibition of particular hypothetical subtelomeric regulatory sequences (r-sequences) determined by progressive telomere shortening; 4) Identification of the r-sequences in the TERRA sequences whose effects are well known and documented. The theory, as proposed in phases 1 and 2, was untenable because the evidence contradicted the predictions. The theory, as proposed in phase 3, was based mainly on the hypothetical existence of regulatory sequences that required empirical confirmation. The further development of the theory in phase 4 overcame this difficulty. In particular, the identification of hypothetical r-sequences in widely documented sequences such as the TERRA sequences has transformed a hypothesis into a theory confirmed by empirical evidence. The mechanism proposed describes a genetically determined and regulated mechanism of aging as a program causing specific epigenetic modifications. This confirms the thesis that aging is an adaptive phenomenon and invalidates the opposing hypothesis. Among other things, for the validity of the opposite hypothesis of aging as a non-adaptive phenomenon, it would be essential to justify in evolutionary terms: (i) the position of regulatory sequences of great importance for cellular functions in a position where they are inhibited by telomere shortening; (ii) cell senescence which appears to be an oncogenic factor and so cannot be justified as a defense against cancer; and (iii) gradual cell senescence which cannot be hypothesized as an anti-cancer defense. Furthermore, the phenomena referred to in points (ii) and (iii) and TERRA sequences inhibition are entirely reversible with appropriate manipulations, and this is unlikely with their possible interpretation as a consequence of random degenerative phenomena.
In Japan, a super-aging society, the development of Ikigai is considered the key to extending healthy longevity in national policy. Thus, activities provided by local governments are designed to encourage Ikigai. At this point, Ikigai has developed its conceptual understanding, which includes its distinctiveness from life purposes and other closely related concepts. Empirical studies using developed measurements have shown that Ikigai has an impact on the mental and physical health of older adults across countries and cultures. However, the dynamic nature of the relationship of Ikigai with the social networks of family members and the community, engagements in social activities, and the health and well-being of older adults has room for more evidence. This study examined how Ikigai, in relation to social networks, support, and engagement in social activities, was related to the well-being of older Japanese adults. Using the 14th wave of the Japan Household Panel Survey (JHPS), Ikigai’s relationships with self-rated health and short-, middle-, and long-term happiness were examined using social networks and support and engagement in social activities through a series of regression analyses. The results showed persistent positive relationships between Ikigai and the dependent variables, regardless of the status of social networks and support and engagement in social activity. They also revealed that regular physical activity was consistently associated with happiness. Although simple and not comprehensive, this study provides additional evidence that perceiving Ikigai, as it is with its nuances in Japanese culture, plays a critical role in the well-being of older adults. Furthermore, based on the results, the concept of Ikigai was reviewed and discussed to understand it better.
Caring for patients with neurocognitive disorders (NCD) can be challenging for caregivers, with the risk of malnutrition. Observational, retrospective, monocentric study carried out with patient-caregiver dyads admitted to the Memory Day Hospital of the Gerontology Center of the University Hospital of Lille over 6 months in 2023. Our objectives were to identify the socio-characteristics of caregivers who had recently experienced a variation in their weight, their degree of fatigue (using the Fatigue Numerical Rating Scale), their burden (using the Mini-Zarit scale), and their quality of life (using the WHOQOL-BREF scale). Qualitative variables are represented by numbers and percentages, while quantitative variables are typically reported as the mean ± standard deviation (SD) if the data are Gaussian, or as the median with the interquartile range. Normality was assessed using the Shapiro–Wilk test and visual inspection of histograms. Caregivers were classified into three groups according to weight variation (WV). Comparisons between WV groups were performed using chi-square tests for qualitative variables and Kruskal–Wallis tests for quantitative variables. All tests were two-sided with a 5% significance level and were performed using SAS 9.4. The study included 106 patient–caregiver dyads. The patients were primarily women (64%), with a mean age of 81 years, and were mainly living at home (82%). Two-thirds of them had a major neurocognitive disorder (primarily Alzheimer's disease), with an average Mini-Mental State Examination (MMSE) score of 23/30. The caregivers were mainly women (63%) who lived with their partners. Three groups were identified: spouses (30%, with a mean age of 76); adult children/stepchildren (58%, with a mean age of 55); and others (11%). The support provided was mainly administrative (84%). Nearly three-quarters of caregivers experienced weight variation (WV). Spouses tended to lose weight, while children tended to gain weight. The mean Mini-Zarit score was 2/7. On the WHOQOL-BREF scale, the lowest score was observed in caregivers with weight loss (social relationships). Bivariate analysis revealed that caregiver status, patient NCD severity, and fatigue were significantly associated with WV. Caring is a major social issue, and caregivers, who are often invisible, are gaining recognition, notably through the introduction of a 'carer status' in France. It is essential to raise awareness among the public and health professionals to help identify and support caregivers more effectively. Regularly measuring caregivers’ weight is a simple and cost-effective means of preventing caregiver distress and the risk of burnout. Supporting both patients and caregivers is a key priority.
This study aimed to evaluate the psychometric properties of the Family Inclusion Scale (FIS) for administration to adults and older Mexican adults. To this end, a questionnaire was structured with scales to evaluate family inclusion, loneliness, and perceived stress; the last two scales were previously validated. The sample (n = 347) consisted of young university adults aged 20 to 24 years and their grandparents aged 60 years. The conceptual emphasis of the Family Inclusion Scale generated was the identification of the affective component that facilitates, or does not facilitate, the perception that the focal subject feels positively involved in the family dynamics in which it develops. An Exploratory Factor Analysis was performed to determine the factor structure of the Family Inclusion Scale. This analysis showed that the referred scale consisted of a single factor with eight items. Following this, a preliminary Confirmatory Factor Analysis was conducted to assess the convergent and discriminant validity of the Family Inclusion Scale (FIS). The correlation matrix showed a positive correlation between the FIS and the low-stress perception scale and a negative correlation with the family alienation scale, which was extracted from the loneliness scale. Considering some variation between items, the measurement model showed adequate goodness-of-fit metrics. In conclusion, this work documents the Family Inclusion Scale as an easy and quick questionnaire to apply, which meets robust psychometric properties, supporting its use with samples of Mexican adults.
This article explores the ongoing work associated with the masterclasses "Towards an Inclusive Living Environment." It critically examines the concept of healthy living for all and aging in place by studying neighborhoods within Dutch cities. The article argues that creating inclusive, healthy environments fosters well-being and promotes a lifestyle of health and autonomy for all. Next to literature studies, we worked with our students in different neighborhoods of The Hague, conducting ethnographic research. Through this ethnography, the article identifies shortcomings in various neighborhoods, based on observations and interviews with residents. These insights and the insights of the theoretical background are used to inform discussions with municipal authorities, leading to the selection of design sites. The needs and desires of the community are then translated into design solutions, ranging from neighborhood-level interventions to the transformation of existing buildings or new architectural additions. The article raises critical questions about the consequences of neglecting these pressing needs and highlights successful case studies where improved environments have significantly enhanced the quality of life in Dutch neighborhoods. The students' design approach is presented, but not yet discussed or tested in the neighborhood. They are meant to foster discussions.
