ARCHIVED: Introduction: Age-Friendly Rural and Remote Communities: A Guide

In September 2006, the Federal/Provincial/Territorial (F/P/T) Ministers Responsible for Seniors endorsed the Age-Friendly Rural/Remote Communities Initiative (AFRRCI). The Initiative has two main objectives:

1. to increase awareness of what seniors need to maintain active, healthy and productive lives within their communities by identifying indicators of age-friendly rural or remote communities; and
2. to produce a practical guide that rural and remote communities across Canada can use to identify common barriers, and to foster dialogue and action that supports the development of age-friendly communities.

In an age-friendly community, policies, services, settings and structures support and enable people to age actively by:

• recognizing the wide range of capacities and resources among older people
• anticipating and responding flexibly to aging-related needs and preferences
• respecting the decisions and lifestyle choices of older adults
• protecting those older adults who are most vulnerable
• promoting the inclusion of older adults in, and contribution to, all areas of community life¹

The idea of an age-friendly rural or remote community builds on work underway by the World Health Organization (WHO) on "global age-friendly cities" which is, in turn, based on the WHO’s active aging model.² This Global Age-Friendly Cities Project has attracted enthusiastic interest from the moment it was introduced in June 2005, at the opening session of the XVIII World Congress of Gerontology in Rio de Janeiro, Brazil. The interest evolved into action, with 33 cities in over 22 countries participating in the project. Canada’s AFRRCI was developed using the model and research framework of Global Age-Friendly Cities.³ The Canadian project focuses its work specifically on rural and remote communities. The Initiative has experienced success to date with the participation of 10 communities from eight jurisdictions.

Healthy Aging and Seniors in Rural and Remote Communities

The costs and benefits associated with aging and the impacts on communities and broader society make an investment in healthy aging imperative. While the majority of seniors living at home view their health as good, long-term health problems tend to increase with age—this is the case for most chronic conditions, disabilities and dementias. For example, data from 2001 show that disability rates jump from 31% among seniors aged 65 to 74 years, to 53% for those aged 75 and over.⁴ It is estimated that in the next 10 years, Canadians over age 65 will outnumber those under age 15. Within 30 years, as the Baby Boom generation continues to age, the population over age 65 will grow from 4.2 million to 9.8 million.⁵

The aging of the Canadian population has significant implications for the health system. Currently, 44% of Canada’s total health care expenditures are attributed to seniors who comprise 13% of the population.⁶

At the same time, older adults continue to make significant and numerous contributions on a number of fronts—to their families (by providing assistance to spouses, children and grandchildren); to their friends and neighbours; to the community (through volunteering activities); and to the paid economy as skilled and knowledgeable workers.

Evidence shows that health promotion and disease prevention strategies can help those who are aging well, as well as those with chronic conditions and those who are at risk for serious health problems—even very late in life. It is increasingly recognized that encouraging communities to create age-friendly physical and social environments will better support older citizens in making choices that enhance their health and well-being and allow them to participate in their communities, contributing their skills, knowledge and experience.⁷

While the majority of Canadians live in urban settings, a large proportion of seniors still live in rural or remote areas—hence the focus of this guide on rural and remote communities. It is estimated that approximately 23% of seniors in Canada live in rural areas and small towns.⁸ In fact, some parts of rural Canada have been undergoing increases in the proportion of seniors as retirees migrate from cities to the country.

Current research on rural and remote communities shows they face unique social and environmental challenges that can have an impact on health and healthy aging different from those facing urban populations. For example, seniors who wish to "age in place" in rural communities can face barriers to remaining in their homes and staying active and engaged in their communities. Such barriers include a lack of or limited support available to enable older persons to remain independent, as well as very limited housing and transportation options. In addition, seniors in rural and remote areas are frequently required to travel out of their communities for health services, which creates a range of challenges for themselves and their families.

How the Guide Was Developed

Communities included in this initiative were identified by provincial and territorial governments through a variety of mechanisms, including open calls and invitations to specific communities. All participating communities met a number of criteria related to: population size (5,000 or less), population aging experiences, degree of remoteness (proximity to a city), economic structure (agricultural, resource-based, tourism/recreation-based) and ethnocultural diversity.

A total of 10 communities in eight provinces participated in the focus group research (see Figure 1). They range in size from fewer than 600 to approximately 5,000 people, and represent varying degrees of rurality and remoteness. Some communities are isolated during the winter months and have little contact with other communities; some have agricultural economies, while others are resort towns. These communities also vary in terms of cultural diversity.

Figure 1: Participating Communities⁹

A locally-driven and bottom-up participatory approach was employed to involve and encourage the active participation of older adults in examining and discussing issues related to aging in their community. This participatory approach to decision making and social engagements is a recommendation of the United Nations for empowering older adults. Older adults are the experts about their own lives—the Canadian (AFRRCI) project sought the full participation of seniors in all study communities.

Focus Groups

Ten focus groups, most consisting of eight to ten people, were conducted with older adults (aged 60 and over) and informal caregivers of older adults who were not able to participate due to physical or mental impairment. The group of older persons reflected a variety of ages, physical disabilities and differences in socio-economic status. Potential participants were screened in order to ensure appropriate diversity regarding these characteristics. All participants in the focus group were recruited within the geographical community that was under study. Efforts were made to recruit participants from a variety of sources. A variety of mechanisms were used to recruit participants such as press conferences, newspapers ads, bulletin board notices, word -of-mouth and through the community contacts (members of the community acting as a liaison between the community and the researchers). Community-based religious, social, volunteer and recreational centres where older persons gather and community agencies and services with a large clientele of older persons were also used as recruitment locations. In total, 107 participants (96 older adults and 11 caregivers) participated in the focus groups held between February and April 2007.

An additional 10 focus groups were conducted with a total of 104 service providers from the public, business and voluntary sector. This supplementary information focused on service provider interactions with the older adults. In some cases, caregivers and service providers provided information that the older persons did not report.

Discussion Themes

The study was designed to provide a comprehensive picture of each community’s age-friendliness. Eight broad topics or themes were explored and discussed in the focus groups—themes covered the essential features of the community’s structure and its physical environment, as well as the extent to which its services and policies reflect the determinants of active aging. These eight themes are identical to those used by the World Health Organization in the Global Age-Friendly Cities: A Guide . The same broad questions were asked in each community. The discussions were focused on elaborating the following:

• the aspects of the community that are age-friendly (advantages),

• the barriers and problems that show how the community is not age-friendly (barriers), and

• suggestions to improve the problems or barriers identified.

The first three topics were Outdoor Spaces and Buildings, Transportation and Housing. As key features of a community’s physical environment, these aspects of community have a strong influence on personal mobility, safety from injury, security from crime, health behaviours and social participation. Three other topics reflect various aspects of social environments and of culture that affect participation and mental well-being—Respect and Social Inclusion deals with the attitudes, behaviours and messages of other people and of the community as a whole towards older persons; Social Participation refers to the engagement of older persons in recreational, social, cultural, educational and spiritual activities; and Civic Participation and Employment Opportunities addresses opportunities for citizenship, and paid and volunteer work—it is related to both social environments and the economic determinants of active aging. The remaining two themes, Communication and Information and Community Support and Health Services, involve both social environments and health and social service determinants.

These aspects of community life, while presented separately in this guide, are clearly interrelated and discussion in the focus groups often wove together various issues across themes. For example, respect and social inclusion are reflected in the accessibility of buildings and spaces, and in the range of opportunities offered to older persons for social participation, entertainment or employment. Housing influences the need for community support services—social, civic and economic participation partly depend on the accessibility and safety of outdoor spaces and public buildings. In particular, transportation, communication and information interact with the other themes—without transportation or adequate means of obtaining information to allow people to meet and connect, other rural facilities and services that could support active aging become inaccessible.

In this Guide

This guide has been organized to reflect the discussion and suggestions related to the eight themes outlined above. In Section II, each theme is discussed separately. Following a synopsis of the discussion highlights related to a theme, a summary of key findings identifies the aspects of a community (related to the theme) that make a community age-friendly, as well as barriers to and some suggestions for achieving age-friendliness identified in the focus group discussions. Section III sets out a broad process that communities may follow to consider and address the age-friendliness of their community, and a detailed checklist of age-friendly features that may assist communities to better meet the needs of their older adults.

It should be noted that this guide reflects the broad and most frequently mentioned age-friendly features and barriers from discussions across Canada, including some suggestions from participants for making their communities age-friendly. This guide is not exhaustive. Each community is unique and discussions pointed to the fact each has a unique set of needs, circumstances and options for improving age-friendliness. The ideas and suggestions presented here will need to be considered by each community and adapted and tailored to best meet local conditions and needs.

How to Use the Guide—A Starting Point

This guide is intended to be used by individuals and groups interested in making their community more age-friendly, including local and provincial governments, voluntary organizations, the private sector, seniors, senior-serving organizations and citizens’ groups. Making communities age-friendly is a shared responsibility among many groups including the various levels of government. The guide is designed to illustrate what is meant by "age-friendly" and to provide communities with a starting point to identify common barriers and assets in their communities and foster dialogue and action that support the development of age-friendly communities.

It is everyone’s responsibility to begin a dialogue in their communities in order to determine their assets, their strengths and weaknesses as an age-friendly community. How each community chooses to undertake this task will vary.

Ideally, community dialogues will involve all members of the community in the exploration of age-friendliness, as many of the features that benefit older adults can also benefit other groups in the community. A community that works for seniors works for everyone.