Despite well-documented health benefits, outdoor stays remain limited for older adults living in residential care facilities (RCFs) across Europe. This position paper compares governance, policy, and research in the Netherlands, Finland, and Sweden, identifying key barriers, particularly for persons experiencing physical or cognitive decline. Drawing on three theoretical models, the paper highlights a persistent gap between evidence and practice, and calls for the establishment of legal rights, national strategies, and international guidelines to ensure equitable access to outdoor stays. Contact with nature and outdoor stays should be recognized not as optional amenities, but as fundamental human needs in later life.
As society ages, neighborhood open spaces that offer restoration, reduce stress and attention fatigue, and thereby support older adults' mental health become increasingly important. However, current research mainly focuses on young adults. Using a choice-based experiment (N = 301, Mage=75.5), we examined older adults' preferences for eight design attributes. Distance from home proved significant, emphasizing the need for nearby restorative spaces. Preferences differed from patterns reported for younger adults: while greenery is valued across ages, openness, terraces and presence of others appear especially important for older adults' restorative experiences. These findings inform age-inclusive restorative urban design.
This study explores the relationships between environmental perceptions, attitudes toward community participation, and third place engagement among older adults, using survey data from 638 individuals aged 65 and older residing in Orlando, Florida. The analysis focuses on differences by living arrangement. Ordinary least squares (OLS) regression models were used to examine third place engagement as a continuous outcome, with analyses stratified by whether individuals lived alone or with others. Findings show that physical accessibility - particularly proximity to third places and walkable reach - is a key factor in engagement for both the overall sample and the subgroups. Perceived walkability and neighborhood safety also contributed significantly, emphasizing the role of built environment quality in fostering social connection. Among those living alone, positive attitudes toward exercise and community interaction were associated with higher levels of engagement, suggesting that personal motivation interacts with environmental conditions. The results highlight the need for age-friendly urban design that supports both physical and social accessibility. Policies that enhance walkability, improve neighborhood safety, and locate third places within residential areas can strengthen social participation, particularly among older adults living alone.
Hospital gardens play a significant role in supporting the physical and psychological well-being of patients, healthcare staff, and visitors. However, limited empirical research has examined how user preferences vary across different spatial components of hospital gardens. This study investigates user-based design priorities for hospital garden environments through a visual and quantitative evaluation approach. A questionnaire survey was conducted with doctors, nurses, hospital staff, and patient relatives in a training and research hospital located in Bursa, T & uuml;rkiye. Participants evaluated visual simulations of four proposed landscape design scenarios using a five-point Likert scale. The data were analyzed using non-parametric statistical tests. The results indicate that planting design is the most influential component in interior atriums and open green spaces, while planting and structural elements hold comparable importance along pedestrian paths. In contrast, no dominant design parameter was identified for children's playgrounds, suggesting a balanced contribution of multiple design elements. These findings highlight the importance of considering diverse user profiles and spatial characteristics in hospital garden design and provide evidence-based guidance for developing user-oriented healing environments.
The study aims to explore the changes to physical activities and home adaptations after fall among older adults in Malaysia. Housing in Malaysia is often not designed with the needs and safety of the elderly in mind. However, falls affect several Malaysians aged 60 years and above, and most falls occur in and around individuals' homes. This paper examines changes to physical activities and the physical home environment post-falls. In addition, the paper will also discuss the attitude toward home modifications. Home-visit interviews were conducted on 10 University of Malaya Medical Center (UMMC) patients who sustained at least one injurious fall or more at their respective houses in the past 6 months. In addition to in-depth interviews, observations were made, including sketching a floor plan and recording images, to understand the physical activities and movement patterns of the participants after falls. The study found limited physical activities due to Fear-of-Falling (FOF) after they returned to the house. The movement pattern shows that the participants spend most of their time in the living room and bedroom after the fall. There was a low level of interest in home modifications after the patients had returned to their homes due to several reasons.
Dementia is a challenge, which the World Health Organization categorizes as a public health priority. Knowledge on prevention, treatment, care, and cure is needed. This case study investigates the potential of using smell at nursing homes to support the well-being of people with dementia. The study includes participant observation, interviews as well as spatial and sensory analysis. The results cover information on the use of smell, the challenges, and the possible benefits, categorized under the following themes: smell as part of a sensory-stimulating environment; open to smell impressions; minimizing smell nuisances and competing smells; the use of smell; selecting smells; and the potential effects of smell. As a component of a sensory environment where smell is supported by other types of stimuli, the targeted use of smell holds good potential for benefiting people with dementia.
Alzheimer's disease (AD), a growing concern worldwide, affects memory, cognition, and daily functioning. As the need for supportive environments increases, interior design plays a crucial role in alleviating AD-related challenges by enhancing orientation, independence, and social interaction. This research aims to evaluate existing environments for dementia care facilities serving individuals with AD using evidence-based methods to inform future interior design efforts and to provide links between local cases and global discussions. This qualitative research is grounded in field observations from three Alzheimer's care centers in Turkey, semi-structured interviews with their healthcare professionals, and a comprehensive literature review. It evaluates the spatial layout, interior comfort, and facility equipment by examining their effects on patients' cognitive, sensory, and social well-being. The results are then compared to Alzheimer-friendly design principles developed by Fleming and Bennett, as highlighted in the World Alzheimer Report 2020. The results demonstrate that well-designed spatial environments can significantly support the needs of individuals with AD by enhancing sensory engagement, facilitating spatial orientation, and promoting social interaction. It also emphasizes the importance of customizing global design principles to fit local care practices. This research integrates international evidence-based design frameworks with Turkey's specific care context, supporting the development of therapeutic interior environments and furthering the discussion on dementia care design.
Aging, as a natural phase of life, brings limitations that necessitate adapting urban spaces to meet the needs of the elderly. With a growing proportion of urban parks users being elderly, ensuring their access to these spaces is crucial. This study evaluates parks in Tabriz Municipality's 10 districts to assess how well their environmental affordances cater to the elderly. The research, quantitative and applied in nature, identifies four key areas of environmental affordance: physical, cognitive, psychological, and symbolic. Through field observations and questionnaires completed by elderly park users, data were collected from 140 participants using purposive quota sampling. SPSS software was employed for analysis, utilizing multivariate analysis of variance repeated measures and independent-sample t-tests. Findings reveal that Bagh Emami and Hashtroodi parks (districts 3 and 9) scored highest in environmental affordances, while Razi and Atashneshani parks (districts 7 and 5) scored the lowest. Physical affordance was the most emphasized and highest scoring aspect, whereas symbolic affordance received the least attention.
Living in high-rise apartments may influence how often older adults go outside. By using data from the Japan Gerontological Evaluation Study, this study examined the associations of housing type and apartment floor level with frequent out-of-home activities among community-dwelling older adults. Modified Poisson regression showed that people living on the 2nd-3rd floor (adjusted prevalence ratio: 1.10, 95% confidence interval: 1.04-1.16) and 4th-5th floor (1.10, 1.04-1.17) of apartments with elevators engaged in out-of-home activities significantly more frequently than those living on the 1st floor. Housing structures may therefore shape health-related behaviors in older population.
The aging of the world's population has increased the importance of understanding older adults' needs and designing spaces accordingly. As older individuals spend most of their time at home, especially in living rooms, design decisions in this place play a key role in user comfort and satisfaction. Among interior design elements, artificial lighting, especially correlated color temperature (CCT), significantly influences visual comfort and residential satisfaction. This study compares the importance, current use, satisfaction, and ideal CCT preferences for general living room lighting among adults aged 65 and older and those under 65. Data were collected from 124 participants (62 per group). Results indicate that most participants consider CCT important and are satisfied with their current CCTs. While individuals over 65 tend to use cooler CCTs, those under 65 prefer warmer or neutral tones, and ideal preferences largely align with existing usage. Despite differences in CCT use and preference between age groups, no significant difference in satisfaction was found.
Despite the importance of living environments for older adults' social participation, little was known about the influence of micro-, meso-, and macro-environments. Using semi-structured interviews and naturalistic observations, this multiple-case study explored the perspectives of 12 older adults at risk of isolation across dwelling settings. Environmental factors influencing social participation included dwelling design, social networks, mobility aid access (micro); gathering places, residential atmosphere, on-site activities, and convenient transportation (meso); and paratransit regulations and housing affordability (macro). Offering a multi-level perspective, these findings underscore the need to integrate social opportunities into housing and neighborhoods for older adults at risk of isolation.
Mobility is central to aging in place, yet older adults' transportation experiences are shaped by the interaction of housing conditions, transportation systems, and functional capacity. Drawing on person-environment exchange perspectives in environmental gerontology, this study examines how housing-related cost pressures and transportation disadvantage jointly influence transportation dependence and realized mobility among adults aged 55 and older. Using survey data, we estimate multivariable regression models and test moderation and mediation pathways to clarify underlying mechanisms. Transportation disadvantage-defined as the cumulative presence of car unavailability, lack of smartphone access, and reliance on assistance for travel-emerges as a strong and consistent predictor of reliance on dependent transportation modes and destination-specific mobility. Greater transportation disadvantage is associated with increased medical trip-making and reduced social participation, while grocery trip frequency shows no independent association once access constraints are accounted for. In contrast, combined housing and transportation cost burden and housing tenure exhibit no direct, conditional, or indirect effects on mobility outcomes. These findings highlight the central role of proximal access constraints in shaping mobility in later life and underscore the limits of cost-based affordability measures for understanding everyday transportation experiences among older adults.
Physical activity is influenced by built environment, but these associations may differ according to functional capability and subjective and objective environmental measures. Using data from a mail survey of 5,489 community-dwelling older adults, we examined associations between neighborhood environments and physical activity across functional capability levels. Objective environmental factors were associated with physical activity only among the robust group, whereas subjective environmental factors were associated with physical activity across all functional capability groups. These findings suggest that associations between neighborhood environments and physical activity vary by functional capability and highlight importance of policies addressing both subjective and objective environmental factors.
The digital divide and perception of insecurity are challenges deterring social participation of older persons in Mexico, where age-friendly environments are being promoted in response to population aging. This cross-sectional study involving 445 older adults in Guadalajara, Mexico, assessed the relationship between information and communication technology (ICT) access/use and group physical activity, formal/informal education, social participation, and quality of life. After adjusting for perceived insecurity, multimorbidity, and sociodemographics, higher ICT engagement was significantly linked to more favorable outcomes across all domains, highlighting digital inclusion as a factor associated with active and healthy aging in middle-income urban settings.
The convergence of youth migration and the disintegration of joint families have resulted in households with older adults living alone or with a spouse. Despite the potential to relocate with their kin afar, older adults in migrant households often choose to age in place amidst the vulnerabilities of long-distance care. The study aims to explore the perceptions and experiences of aging well in migrant households using an inductive approach. In-depth interviews were conducted with 20 older adults who age alone or with their spouse in migrant households in three geographic zones of Kerala using purposive sampling. Thematic analysis revealed four major themes: a sense of belonging, social support and exchange, autonomy, and challenges in relocating with children abroad are the reasons for older adults to age well in place. The study findings reveal that support from neighborhoods, religious groups and extended families helps individuals age well in place, even when in-person intergenerational care is compromised. Targeted interventions, including community-based support groups, digital interventions, and home-based care assistance that foster aging well in place, are imperative in addressing the care demands of older adults.
This study investigated whether public senior housing mitigates the effect of low income on depression among older adults in South Korea. Data were drawn from two sources: the Public Senior Housing Residents Survey (n = 119) and the 2018 Seoul Welfare and Living Conditions of Older Adults Survey (n = 519). Regression analyses examined the independent contributions of income and housing type to depressive symptoms among older adults living alone and below the poverty line. Results indicated that low income was associated with higher levels of depression, but residence in public senior housing alleviated this detrimental effect. Public senior housing that integrates comprehensive care services and structured social activities appears to provide protective benefits. These findings suggest that public senior housing may serve as an important housing alternative for low-income older adults living alone who are particularly vulnerable to depression, underscoring its potential relevance for policy and future research on housing and well-being among older adults.
Today's changing context of healthy aging includes continued advancement in digital technologies. Through a community survey of 364 older adults in Singapore, we assessed five types of digital skills: "operational internet skills," "information navigation skills," "social skills," "creative skills," and "mobile skills," applying the LSE digital skill measurement instrument. We identified how distinct types of digital skills contributed to internet and digital technology use for health promotion activities: (i) to improve eating habits, (ii) to access healthcare, and (iii) to access long-term care services. Ordinal logistic regression was applied treating age, gender, education, and income as covariates. Mean age was 73.86 +/- 6.07 years; 74.30% were female. Among five types of digital skills, higher "operational internet skills" and "creative skills" contributed to better engagement in internet and digital technology use for health promotion activities. Higher "social skills" and "information skills" lead to better use of the internet and digital technology to improve eating habits, whilst greater "social skills" improved access to healthcare. "Mobile skills" had a significant positive association with using internet and digital technology to access long-term care services. Therefore, leveraging digital skills among older adults can promote healthy lifestyles via the internet environment and help to create digitally inclusive healthy aging communities.
This study investigates how nursing home architecture shapes older adults' experience of autonomy. Using thematic analysis of interviews and observations across six nursing homes in Tehran, Iran, it examines how spatial features facilitate or create obstacles to residents' autonomy. Three key themes emerged: (1) accessibility and freedom of movement, (2) resident-directed sensory and environmental settings, and (3) home-like design and environmental personalization. The findings reveal that while safety concerns often restrict autonomy, thoughtful design can enhance residents' agency. By integrating spatial and personal perspectives, this research offers a holistic understanding of autonomy in long-term care, emphasizing the vital role of the built environment in supporting older adults' daily lives.
