Constructing an Age-friendly City (AFC) has become a major public policy imperative in response to global population aging and urbanization. Yet there is a dearth of empirical evidence on how AFC initiatives can improve perceived age-friendliness among community-dwelling older adults, and on how such initiatives may differently affect older adults with different socioeconomic statuses. Drawing on a three-year citywide AFC initiative in Hong Kong, we conducted a trend study to evaluate changes in perceived age-friendliness in eight AFC domains with 2575 and 2697 community-dwelling older adults in 2015 and 2018 respectively, in addition to 36 focus groups involving 206 older adults. Participants were asked to share their views on changes in age friendliness in their cities. Survey data were analyzed using linear regression while focus group data were analyzed using thematic analysis. Significant improvements were found in perceived age-friendliness in all eight AFC domains. Low-income older adults saw the greatest improvements in age-friendliness. Thematic analysis revealed that despite improvements, shortcomings persist in domains of housing, civic engagement, and employment. Nevertheless, our findings demonstrate that concerted efforts can improve a city's overall age friendliness, and that such improvements appear most evident among low-income older adults.

Abstract Research on enhancing social capital among older adults in East Asia often neglects the aspects of trust, norms, and reciprocity, focusing primarily on social participation. Moreover, it frequently overlooks the capacity of older adults for collective action within society. This study addresses these gaps by exploring strategies that enable older adults in Hong Kong to shift from being passive service recipients to active participants in community and collective action. Using a qualitative research design. We conducted focus groups with 43 participants over 60, who were committee members of various socially beneficial groups, including self-initiated and NGO-led groups. These groups engaged in activities such as promoting age-friendliness, ageing in place and ecological conservation. Data were collected through semi-structured interviews and analyzed using deductive and inductive thematic analysis based on Nahapiet and Ghoshal’s framework. The findings identified five key strategies to enhance social capital among older adults: establishing connections with trusted intermediaries, transforming individuals to share collective goals, providing stable platforms for trust-building, facilitating informal interactions to enhance cohesion, and leveraging influential figures to reinforce group norms. These strategies empower older adults and integrate them into the broader social fabric, thereby contributing to collective action. The study provides actionable insights for policymakers and social workers to develop interventions that enhance social capital among older adults, thereby leveraging their potential as active societal contributors.

ObjectivesService accessibility plays a pivotal role in older adults' mental health. However, accessibility measures used in previous studies are either objective or perceived. This study aimed to integrate both objective and perceived measures of service accessibility to explore the relationship between environmental cognition on service accessibility and mental health in older adults and the pathways.MethodsWe used both questionnaire data collected from 2,317 older adults in Hong Kong and geographical data to explore the direct and indirect effect of environmental cognition (i.e. positive, negative, and matching evaluation) relating to service accessibility on mental health and two pathways (i.e. physical activity and sense of belonging) based on a structural equation model.ResultsPhysical activity mediated the positive relationship between non-negative perceptions toward access to convenience stores, leisure facilities, clinics, community centers, places of worship and mental health. Sense of community can significantly mediate the positive relationships between non-negative perceptions toward all 10 types of services and mental health.ConclusionThis study provides an empirical contribution to environmental cognition theory and person-environment fit theory; its findings have implications for urban planning policy. The findings from this study provide significant evidence that environmental cognition distortion, especially negative perception, can be significantly associated with lower mental health through physical activity and a sense of community. This suggests that policies focused on changing environmental cognitions could be a promising public health strategy. Environmental cognition theory suggests that improving awareness of setting could help improve the precision of cognitive mapping of environmental reality. This can be very important where it is difficult to change the objective environment due to the deep-rooted and long-standing urban structure.

Background and Objectives The construction of an Age-Friendly City (AFC) requires active contribution from relevant interest groups including older adults, nonprofit organizations, and policy-makers. However, given that relevant interest groups may have limited resources, knowledge, and skills, as well as unique contextual factors, they often require help from intermediary organizations-actors that aim to build interest groups' capabilities. Our objectives were to examine the functions of universities, as an example of intermediary organizations, in facilitating the construction of an AFC, and identify critical factors that enable intermediary organizations to perform their functions. Research Design and Methods We conducted three focus groups and one individual interview with multiple interest groups including older adults and social workers from nonprofit organizations and local government involved in a 6-year citywide AFC project in Hong Kong. Participants were asked to share their views on the role of universities in relation to their own experiences and roles in the project. Data generated from the interviews were analyzed using thematic analysis. Results Four themes pertinent to the functions of universities in facilitating development were identified: facilitating cross-sector collaborations, knowledge diffusion, interest-group building, and mediating divergent interests. We also found that neutrality and reputability are key characteristics for intermediary organizations to wield sufficient legitimacy to perform their functions efficiently. Discussion and Implications Findings underscore the important yet overlooked role of intermediary organizations in bridging and mediating different interest groups to facilitate AFC development. We advance gerontological scholarship by providing insights into the theoretical mechanisms and practice implications for intermediary organizations in fostering an AFC.

Little is known about how public open space (POS) environment quality and vitality influence older adults' functional ability and mental health over time. POS vitality refers to the capacity of POS to accommodate a variety of users and activities. We undertook a four-year longitudinal survey of 2081 older adults in Hong Kong to investigate longitudinal relationships between POS environment quality, POS vitality, functional ability and mental health. We applied environment quality evaluation and space use behavior observation to collect data on the environment quality and vitality of POSs within the 200-m buffer area of participants' residences. POS environment quality attributes included the number of leisure facility types, accessibility, shade, and bench quality. POS vitality attributes comprised the diversity of users and activities. We used the Chinese Lawton Instrumental Activities of Daily Living Scale to measure older adults' functional ability and the Geriatric Depression Scale (15-item) to evaluate mental health. We applied latent growth curve models to analyze the longitudinal associations. Accessibility to POS and social interactions among users in POS were related to better functional ability and mental health among older adults at baseline. The number of leisure facility types, and social interactions among users in POS led to a slower decline in functional ability over time. However, there were no significant associations between POS and mental health over time. These findings have theoretical implications for the healthy aging research framework and practical insights for planning policies using POS as an intervention tool to facilitate older adults' healthy aging.

Ageism is a global challenge and a public health concern that the recent COVID-19 pandemic has further exacerbated. Existing research has mainly focused on individual factors, overlooking the association between the neighborhood-built environment and ageism. This study examined this association and whether its effect varied among areas possessing different socioeconomic characteristics. We conducted a cross-sectional survey of 1278 older people in Hong Kong and merged this with the built environment factors derived from geographical information system data. We used multivariable linear regression to examine the association. Findings revealed that more parks were significantly associated with a lower level of ageism, an impact that remained significant in low-income or low-education areas. Conversely, more libraries in high-income areas were associated with a lower level of ageism. Our findings provide urban planners and policymakers insight into planning for the built environment that reduces ageism enabling older people to achieve a better life.

Abstract There is little understanding about how a dementia-friendly community can be constructed in East Asian societies, particularly in geographically remote areas characterized with majority older adult residents and limited external support. A pilot project using an asset-based community development (ABCD) approach in constructing a dementia-friendly community in Hong Kong was implemented. Informed by the theoretical tenets of ABCD, the purpose of this paper is to examine the effects of this pilot project in enabling older adult residents and other community stakeholders to better respond to challenges resulting from growing prevalence of dementia. Multiple stakeholder interviews were conducted with older adult residents, church leaders, district councillors, and social workers. Participants were asked to share the strengths and challenges of this ABCD pilot project in building a dementia-friendly community. Data generated from interviews were analyzed using thematic analysis. Four key preliminary themes were identified, including on the individual level: enhanced dementia literacy, and enacted proactive behaviour; and on the community level: strengthened bridging social capital, and improved community caring capacity. Uncertain long-term financial and professional support posed challenges to participants. Nevertheless, findings underscore the importance of departing from traditional service delivery models, to one that infuses ABCD approaches in constructing a dementia-friendly community. Mobilising existing human and social capital in the community, and embedding older adults in co-creating solutions are key to improve dementia-related interventions. We contribute to ongoing theoretical and practice discussions on the intersections between population aging and employing community-based solutions to create a more dementia-friendly society.

BACKGROUND AND OBJECTIVES:Dementia care creates ethical and legal dilemmas due to the struggle to balance the quality of care and personhood. Disagreement and conflict in caregiving relationships are common. However, limited attention has been given to particular stressful circumstances, such as care practice and decision disagreements. Moreover, the cultural context of personhood has been overlooked. This study drew on Hong Kong family caregivers' reports of their cargiving practice and disagreements with care recipients about care-related decisions and their implications for personhood to identify person-centered family care support needs.RESEARCH DESIGN AND METHODS:We conducted 18 semi-structured interviews with family caregivers of people with dementia in Hong Kong, China. Participants were asked to share their family dementia caregiving experience and practice, specifically regarding decisions and practices that elicited disagreement. We used thematic analysis to analyze data generated from interviews.RESULTS:Six caregiver practices were identified: exchange for mutual agreement, a foot-in-the-door approach, acceptance of requests/behaviors contrary to the caregivers' views, infantilization, treachery, and exclusion and imposition.DISCUSSION AND IMPLICATIONS:These findings highlight the importance of providing support and guidelines for person-centered care to promote personhood in the family caregiving context in dementia care.

Background Older adults were perceived as a vulnerable group during the COVID-19 pandemic due to the health and mental health challenges they faced. The pandemic was accompanied by an “infodemic” of overabundant and questionable information that has affected older adults’ mental health. As the infodemic and ageist narratives were prevalent online, more anxiety symptoms have been induced among older adults who used social media. Age-friendly communication, advocated by the World Health Organization’s Age-friendly City (AFC) guide, could be an antidote by providing tailored information via appropriate channels for older adults. Objective This study investigated the role of community capacity for age-friendly communication in mitigating anxiety during the pandemic. We hypothesized that age-friendly communication would moderate the effects of infection risks and social media use on anxiety. A double-moderating effect was hypothesized in the context of diminished trust in traditional media. Methods Data were collected from a cross-sectional telephone survey conducted in Hong Kong in 2020. Older adults (N=3421, age≥60 years) were interviewed about their well-being and daily lives. Community capacity for age-friendly communication was measured in a living district–based evaluation. It had 2 components: the reach of appropriate information to older adults (AFC-Information) and the age-friendliness of communication technologies (AFC-Communication Technology) in the community. We tested the hypothesized moderation and double-moderation effects with ordinary least squares regressions. Results Perceived COVID-19 infection risk (b=0.002, P=.02) and use of social media for COVID-19 information (b=0.08, P=.04) were associated with more anxiety symptoms. The effect of using social media was moderated by AFC-Information (b=–0.39, P=.002) and AFC-Communication Technology (b=–1.06, P<.001), and the effect of perceived COVID-19 infection risk was moderated by AFC-Information (b=–0.03, P=.002) and AFC-Communication Technology (b=–0.05, P<.001). Lower trust in traditional media exacerbated anxiety symptoms associated with social media use (b=–0.08, P=.02). Higher AFC-Information alleviated this moderation effect (AFC-Information × media trust b=–0.65, P<.001; AFC-Information × social media use b=–2.18, P<.001; 3-way interaction b=0.40, P=.003). Conclusions Our findings highlight the role of community age-friendly communication in mitigating anxiety related to the infodemic. Although using social media may have exacerbated the impact of the infodemic on older adults, it has the potential to deliver timely information for an adequate health response. Although the amplifying effects of low media trust was associated with social media use, age-friendly communication determined its strength. Instead of discouraging the use of digital technologies for COVID-19 information, efforts should be made in tailoring information and communication technologies in local communities for older adults.

Abstract Older adults are more dependent on their surrounding environment. Extensive research has demonstrated beneficial effects of both nature and built environment on mental health of older people. However, most previous research used cross-sectional designs failed to test the intraindividual variability between environment, behavior, and mental wellness in daily life. We used ecological momentary assessment (EMA), activity sensors, and GPS tracking to examine the association between real-time environment, mobility and activity, and momentary affect among older adults in Hong Kong. Data collection and data processing was conducted from December 2021 to May 2022. 168 older adults aged 65 to 84 received seven EMA prompts per day during a fifteen-day period, and completed a total of 17,345 momentary assessments of affective states, mobility, and activities. A set of GPS-derived indicators were used to measure the real-time environment. To disaggregate the between- and within-person effects, we used multilevel models to estimate three dimensions of affect, i.e., valence, calmness, and energetic arousal, in EMA observations, nested within individual participants. Preliminary results indicate significant concurrent associations between environmental attributes and momentary affect at the within-person level, while the between-person differences appear to be either null or modest. Being out of home is associated with higher valence ratings (b=0.04, p=0.0427), while exposure to green is associated with a lower level of energetic arousal (b=-0.03, p=0.0163). Greater walkability is consistently associated with higher momentary affect ratings in three dimensions, but these associations are not statistically significant. Implications of these findings for promoting healthy aging will be discussed.

Background and Objectives Neighborhood environments are increasingly recognized as associated with mental well-being among older adults. However, their underlying mechanisms remain unclear. This study investigated mediating effects of cognitive and structural social capital (SC) in relationships between neighborhood environments and mental well-being among older adults. Research Design and Methods We conducted a cross-sectional analysis of 1,277 community-dwellers aged 60 years and older in Hong Kong in 2021. The Warwick-Edinburgh Mental Well-being Scale assessed mental well-being. Perceived age-friendly environment was assessed. Objective neighborhood environment was measured by the number of neighborhood facilities (e.g., transportation, community centers, leisure facilities) within 200-m and 500-m buffer areas from respondents' residences. Structural equational modeling was used. Results Perceived age-friendly environment regarding community and health support had a protective role on mental well-being. More community centers were directly associated with better affective-emotional well-being, while more passive leisure facilities directly lowered psychological-functioning well-being. Cognitive SC outweighed structural SC in mediating relationships of neighborhood environment on mental well-being. Discussion and Implications Our findings advance the ecological model of aging by providing evidence for cognitive and structural SC as mediators to explain the relationship between neighborhood environment and mental well-being. Policy implications for optimizing mental well-being in aging societies are discussed.

Objectives: Maintaining good cognition is crucial in later life. However, most existing research has focused on individual factors impacting cognition, and few studies have investigated the association between neighborhood built environment and older adults’ cognition. This study examined the association between neighborhood built environment and cognition among community-dwelling older adults and identified variations in this association between different age groups in the older population.Methods: Data were derived from a cross-sectional survey of 1873 people aged 65 years and above in Hong Kong. We merged individual data from the survey with neighborhood built environment data based on community auditing and geographical information system. After controlling for individual covariates, we used multivariable linear regression to examine the association between neighborhood built environment and cognition.Results: Residents aged 80 and younger in neighborhoods with a higher land-use mix and more public transport terminals exhibited better cognition. Only the number of community centers in a neighborhood was positively associated with cognition for people older than 80.Conclusion: The built environment creates diverse impacts on different age groups among older adults. Our findings provide useful information for urban planners and policymakers for planning community facilities and built environments that consider the needs of different age groups within the older population.

Abstract Few studies have explored the underlying pathways between environment cognition (i.e., perception of environment) and mental health in older adults. We tested the mediation effects of physical activity and place attachment in the relationship between environmental cognition and mental health, based on a survey study of 1,553 older adults in Hong Kong using structural equation model. The results showed that significant relationship between negative environmental cognition (i.e., residing in higher accessible area but perceive lower) on access to convenient stores, leisure facilities, clinics, community centers, religious places and lower mental health can be explained by lower daily average physical activity time. Place attachment can significantly mediate the positive effect of positive environmental cognition (i.e., residing in lower accessible area but perceive higher) towards all types of services on mental health. Findings from this study have policy implication for urban planning and age-friendly community design

OBJECTIVES:Neighborhood built environments (BEs) are increasingly recognized as being associated with late-life depression. However, their pathways are still understudied. This study investigates the mediating effects of physical and social activities (PA and SA) and functional ability (FA) in the relationships between BEs and late-life depression.METHODS:We conducted a cross-sectional analysis with data from 2,081 community-dwellers aged 65 years and older in Hong Kong in 2014. Two road-network-based service area buffers (200- and 500-m buffers) adjusted by terrain and slope from participants' residences were created to define the scope of neighborhoods. BEs comprised population density in District Council Constituency Areas, urban greenness, land-use diversity, and neighborhood facilities within 200- and 500-m buffers. Multilevel path analysis models were used.RESULTS:More urban greenness within both buffers and more commercial facilities within a 500-m buffer were directly associated with fewer depressive symptoms. SA mediated the relationship between the number of community facilities and depressive symptoms within a 200-m buffer. Neighborhood urban greenness and the number of commercial facilities had indirect associations on depressive symptoms within a 500-m buffer, which were mediated by FA.DISCUSSION:Our findings have implications for the ecological model of aging. The mediating effects of SA and FA underscore the importance of promoting active social lifestyles and maintaining FA for older adults' mental health in high-density cities. Policy implications on how to build age-friendly communities are discussed.

Studies have indicated that a sense of community may be shaped by the built environment and has potential mental wellbeing implications. However, few studies have explored this pathway empirically. Moreover, research has rarely differentiated the role of objective and perceived built environment. Based on a survey of 1,553 older adults undertaken between 2015 and 2017 in Hong Kong, we explored the distal mediation pathway from objective built environment to both mental health and subjective wellbeing through perceived built environment and sense of community, using multilevel structural equation modeling. The results showed that perceived built environment and sense of community can fully explain the residential density and subjective wellbeing relationship. The inverted U-shape relationship between street connectivity and mental health was identified. Park-based green space had a protective role for both mental health and subjective wellbeing and was explained by two mediators, but vegetation-based green space was negatively associated with subjective well-being. Land use mix had positive total effects on both mental health and subjective wellbeing and was partially mediated by perceived built environment and sense of community. Recreational services showed a protective effect on both mental health and subjective wellbeing, and both were partially mediated by two mediators. The negative direct effect of health services on subjective wellbeing offsets the positive indirect effect through two mediators. The study findings have implications for landscape and urban planning policy and can provide an empirical contribution to the theoretical foundation of aging in place.

Abstract This study examined the association between neighbourhood physical environment and cognition among community-dwelling older people and identifies whether this association varies among different older age groups. Data came from a cross-sectional survey data with 2,081 older people living in 12 public housing estates in Hong Kong. We merged individual data with neighbourhood physical environment data from community audit and GIS. Multivariable linear regression model was used. Young-old who resided in neighbourhoods with a higher land use mix and more public transport terminals, were associated with better cognition. Only the number of community centres was positively associated with the cognition for old-old. A curvilinear association was found between cognition and the number of active leisure facilities in the overall sample and young-old. Our findings could inform urban planners and policymakers on planning community facilities and physical environments based on the needs of older people in different age groups.

Social and civic participation are important tenets for both the age-friendly city and active aging frameworks promoted by the World Health Organization. Yet older adults are often under-represented in civic affairs. This study examines the effects of using photo-voice as a method in facilitating older adults’ civic participation. Specifically, an empowerment-based participatory photo-voice training model was implemented among older adults with limited formal education in Hong Kong. We conducted three focus groups comprising 12 older adults and one in-depth interview with a social worker. Findings revealed that photo-voice is an effective tool in capturing older adults’ views that would have otherwise been difficult to articulate in words or in writing, and in enhancing older adults’ ability and willingness to participate in community and civic affairs. These findings underscore the importance of using novel techniques to build a more inclusive society that incorporates the views of older adults.

BACKGROUND AND OBJECTIVES:There is little understanding about how rapid urban development has affected the extent to which communities are able to optimize health and participation opportunities for older adults in Hong Kong. Our objective was to examine what older residents perceive to be the shortcomings of their communities in meeting their psychosocial and physical needs as they age.RESEARCH DESIGN AND METHODS:In reference to the WHO Age-Friendly Cities Project Methodology: Vancouver Protocol, we conducted nine focus groups comprising 65 participants for an Age-Friendly City baseline assessment in two districts in Hong Kong, China. Participants were asked to share their views on their respective district of residence, and identify aspects of the city they found unfriendly. Data generated from interviews were analyzed using thematic analysis.RESULTS:Five of the following key themes were identified: the failure of public transportation to cater to the needs of older adults; a lack of public space for recreation and socializing; diminishing human interactions in welfare services; physical and financial challenges relating to housing; and workplace discrimination against older adults.DISCUSSION AND IMPLICATIONS:These findings underscore the importance of prioritizing the social welfare of older adults in building a more inclusive and age-friendly city. They also highlight the difficulties in fostering an inclusive environment while ensuring efficiency and profit maximization.

for and struggles of getting residential care service even they did not want to.The above studies encapsulated the dynamics of the psychological aspects resulted from family caregiving of people with cognitive impairment.