Living Environment

Abstract

Apart from personal factors, the living environment constitutes the other major group of factors that contribute to aging well. While there have been many studies on the impact of personal factors, such as lifestyle, socioeconomic, and psychosocial factors on aging well, there have been comparatively few studies on the impact of the living environment on health outcomes relevant for aging populations. This chapter presents findings of studies in spatial and temporal variation in health outcomes among the Hong Kong elderly population, and examines possible causes such as neighborhood characteristics, urban design, air pollution, and environmental temperature, including an environmental scan of one district with respect to the World Health Organization age-friendly city criteria. Comparisons with other countries are made. There are many unanswered questions regarding how various aspects of the environment may affect health outcomes in older people, and also many methodological challenges in addressing these questions. More interdisciplinary research and funding support are needed in order to achieve an optimal living environment for healthy aging.

Appendix 1: Questionnaire

For the following sentences, please use scores 1–6 to indicate your level of agreement with them. A score of 1 indicates strongly disagree, 2 indicates disagree, 3 indicates somewhat disagree, 4 indicates somewhat agree, 5 indicates agree, and 6 indicates strongly agree.

Strongly disagree	Disagree	Somewhat disagree	Somewhat agree	Agree	Strongly agree
1	2	3	4	5	6

Please rate according to your district of residence

*Can rate according to the whole territory of Hong Kong

A	Outdoor spaces and building
1	Public areas are clean and pleasant	1	2	3	4	5	6
2	Green spaces and outdoor seating are sufficient in number, well-maintained and safe	1	2	3	4	5	6
3	Pavements are well-maintained and non-slip, with covered drains	1	2	3	4	5	6
4	Pavements are wide enough, free of obstructions and have dropped curbs to road level for wheelchairs to pass through	1	2	3	4	5	6
5	Pedestrian crossings are sufficient in number and safe for people with different levels of disability, with visual and audio cues and adequate crossing time	1	2	3	4	5	6
6	Drivers give way to pedestrians at intersections and pedestrian crossings	1	2	3	4	5	6
7	Cycle paths are separate from pavements	1	2	3	4	5	6
8	Outdoor safety is promoted by good street lighting and police patrols	1	2	3	4	5	6
9	Commercial services (e.g., shopping mall, supermarket, and bank) are situated together and are accessible	1	2	3	4	5	6
10	Special customer service arrangements are provided, such as service counters for older people	1	2	3	4	5	6
11	Buildings are well-signed outside and inside, with sufficient seating, accessible elevators, ramps, railings and stairs, and non-slip floors	1	2	3	4	5	6
12	Public toilets outdoors and indoors are accessible, sufficient in number, clean and well-maintained	1	2	3	4	5	6
B	Transportation
13	Traffic flow is well-regulated	1	2	3	4	5	6
14	All city areas and services are accessible by public transport, with good connections	1	2	3	4	5	6
15	Public transportation costs are affordable and clearly displayed. The costs are consistent under bad weather, peak hours, and holidays	1	2	3	4	5	6
16	Public transportation is reliable and frequent, including at night and on weekends and holidays	1	2	3	4	5	6
17	Complete information is provided to users about routes and schedules, and list out the frequency of public transportation services for people with disabilities	1	2	3	4	5	6
18	Vehicles are clean, well-maintained, accessible, not overcrowded, and have priority seating. Passengers give the priority seats to the people in need	1	2	3	4	5	6
19	Specialized transportation is available for disabled people	1	2	3	4	5	6
20	Transport stops and stations are conveniently located, accessible, safe, clean, well-lit, and well-marked, with adequate seating and shelter	1	2	3	4	5	6
21	Drivers stop at designated stops and beside the curb to facilitate boarding and wait for passengers to be seated before driving off	1	2	3	4	5	6
22	Alternative transport service is available where public transportation is too limited	1	2	3	4	5	6
23	Taxis can accommodate wheelchair and walking aids, are affordable, and drivers are courteous and helpful	1	2	3	4	5	6
24	Roads are well-maintained, with good lighting	1	2	3	4	5	6
25	Parking and drop-off areas are safe, sufficient in number, and conveniently located	1	2	3	4	5	6
26	Priority parking and drop-off spots for people with special needs are available	1	2	3	4	5	6
27	(For drivers only) Roadways are free of obstructions that block drivers’ vision	1	2	3	4	5	6
28	(For drivers only) Traffic signs and intersections are well-placed and drivers can spot the location easily	1	2	3	4	5	6
29	(For drivers only) Driver education and refresher courses are promoted for all drivers	1	2	3	4	5	6
C	Housing
30	Sufficient, affordable housing is available in areas that are safe and close to services and the rest of the community	1	2	3	4	5	6
31	Sufficient and affordable home maintenance and support services are available	1	2	3	4	5	6
32	Housing is well-constructed and provides safe and comfortable shelter under all weather conditions	1	2	3	4	5	6
33	Interior spaces and level surfaces allow freedom of movement in all rooms and passageways	1	2	3	4	5	6
34	Home modification options and supplies are available and affordable, and providers understand the needs of older people	1	2	3	4	5	6
35	Rental housing is clean, well-maintained, and safe	1	2	3	4	5	6
36	Sufficient and affordable housing for frail and disabled older people, with appropriate services, is provided locally	1	2	3	4	5	6
D	Social participation
37	Venues for events and activities are conveniently located, easily reached by public transport, and accessible	1	2	3	4	5	6
38	Venues for events and activities are well-signed and well-lit, with sufficient seating and toilets	1	2	3	4	5	6
39	Events are held at times convenient for older people	1	2	3	4	5	6
40	Activities and events can be attended alone or with a companion	1	2	3	4	5	6
41	Activities and attractions are affordable, with no hidden or additional participation costs	1	2	3	4	5	6
42	Good information about activities and events is provided, including details about accessibility of facilities and transportation options	1	2	3	4	5	6
43	A wide variety of activities are offered to appeal to a diverse population of older people	1	2	3	4	5	6
44	Gatherings including older people are held in various local community spots, such as recreation centers, schools, libraries, community centers, and parks	1	2	3	4	5	6
45	People at risk of social isolation are supported by consistent outreach services	1	2	3	4	5	6
E	Respect and social inclusion
46	Older people are regularly consulted by different services on how to serve them better	1	2	3	4	5	6
47	Different services and products to suit varying needs and preferences are provided	1	2	3	4	5	6
48	Service staffs are courteous and helpful	1	2	3	4	5	6
49	Community-wide activities attract all generations by accommodating age-specific needs and preferences	1	2	3	4	5	6
50	Older people are included in community activities for “families.”	1	2	3	4	5	6
51	Older people who are less well-off have good access to different services	1	2	3	4	5	6
52	Schools provide opportunities to learn about aging and older people and involve older people in school activities	1	2	3	4	5	6
53*	The community recognizes the present and past contributions of older people	1	2	3	4	5	6
54*	Older people are visible in the media and are depicted positively and without stereotyping	1	2	3	4	5	6
F	Civic participation and employment
55	A range of flexible options for older volunteers are available, with training, recognition, guidance, and compensation for personal costs	1	2	3	4	5	6
56*	The qualities of older employees are well promoted	1	2	3	4	5	6
57*	A range of flexible and appropriately paid opportunities for older people to work are promoted	1	2	3	4	5	6
58*	Age discrimination is forbidden in the hiring, retention, promotion, and training of employees	1	2	3	4	5	6
59*	Workplaces are adapted to meet the needs of disabled people	1	2	3	4	5	6
60*	Self-employment options for older people are promoted and supported	1	2	3	4	5	6
61	Trainings are provided for older workers to understand different post-retirement options	1	2	3	4	5	6
62*	Encourage and facilitate older people in decision making for different organizations	1	2	3	4	5	6
G	Communication and information
63	A basic, effective communication system reaches people of all ages	1	2	3	4	5	6
64	Regular and widespread distribution of information is assured and a coordinated centralized access is provided	1	2	3	4	5	6
65	Regular information and broadcasts of interest to older people are offered	1	2	3	4	5	6
66	Oral communication accessible to older people is promoted	1	2	3	4	5	6
67	People at risk of social isolation get relevant information from trusted individuals	1	2	3	4	5	6
68	Different services provide convenient and person-to-person service on request	1	2	3	4	5	6
69	Print and spoken communication uses simple, familiar words in short, straightforward sentences	1	2	3	4	5	6
70	Printed information has large lettering and the main ideas are shown by clear headings and bold-face type. It includes official forms, television captions, and text on visual displays	1	2	3	4	5	6
71*	Electronic equipment, such as mobile phones, radios, televisions, and bank and ticket machines, has large buttons and big lettering	1	2	3	4	5	6
72*	Telephone answering services give instructions slowly and clearly and tell callers how to repeat the message at any time	1	2	3	4	5	6
73	There is wide public access to computers and the Internet, at no or minimal charge, in public places such as government offices, community centers, and libraries	1	2	3	4	5	6
H	Community and health services
74	An adequate range of health and community support services is offered	1	2	3	4	5	6
75	Health and social services are conveniently located and accessible by all means of transport and can be accessed by people with different levels of disability	1	2	3	4	5	6
76	Health and community service facilities are safety constructed	1	2	3	4	5	6
77	Clear and accessible information is provided about health and social services for older people	1	2	3	4	5	6
78	Home care services, including health and personal care and housekeeping, are available	1	2	3	4	5	6
79	Residential care facilities and designated older people’s housing are located close to services and the rest of the community	1	2	3	4	5	6
80	Different services are coordinated and administratively simple	1	2	3	4	5	6
81	All staffs are respectful, helpful, and trained to serve older people	1	2	3	4	5	6
82	People will not be deprived of health and community support services due to economic barriers	1	2	3	4	5	6
83	Voluntary services by people of all ages are encouraged and supported	1	2	3	4	5	6
84	Community emergency planning (e.g., escape from fire) takes into account the vulnerabilities and capacities of older people	1	2	3	4	5	6
85*	There are sufficient and accessible burial sites (including columbarium)	1	2	3	4	5	6