Getting Ready for a Maturing America

Feb 8, 2012, 6:30 PM, Posted by NewPublicHealth

WalkWise Hendersonville, NC, home of the Walk Wise, Drive Smart campaign to create more pedestrian-friendly environments for senior adults (photo courtesy of

The startling new National Association of Area Agencies on Aging report, "The Maturing of America," concludes that many communities are unprepared for their quickly aging populations, with "nowhere near the level of progress that has to be made to ensure that communities are livable for people of all ages." Last week at the New Partners for Smart Growth Conference, a panel discussed the challenges our nation will face as it ages and how we can better design communities to be healthier and more accessible for all age groups.

Rebecca Hunter, MEd, of the University of North Carolina Institute on Aging and the Centers for Disease Control and Prevention (CDC) Healthy Aging Research Network, said we’re currently facing a "perfect storm" when it comes to aging:

  • Baby boomers are starting to reach “older adult” status
  • There is a vast increase in the “oldest old,” or age 85 and above
  • The economic downturn means we are less and less prepared for the health and social consequences of this trend

We are moving into an era when at least one in five Americans will be age 65 and older, said Hunter. "We need to ensure our communities are livable for all people."

"The time is now for new ways of looking at things," said Mary A. Leary, PhD, Senior Director, Easter Seals Project ACTION, National Center on Senior Transportation & Other Transportation Initiatives. Some startling statistics she shared include:

  • Nearly 40 million U.S. resident are age 65 and older; this will grow to 70 million in the next 20 years
  • The number of Americans age 85 and older will grow by 74 percent in 20 years
  • Three-quarters of older adults live in low-density communities, making it harder for them to get around and age in place
  • More than half of people over age 75 have disabilities

Hunter also said there is the mistaken belief that most of these aging people are or will be in nursing homes, creating the illusion that "we don’t need to worry about them." But the vast majority of older adults remain in their communities, and more and more will want to age in place, said Hunter.

"The environment can either facilitate or impede healthy aging," said Hunter, and we need to aim for the latter.

In order to help older adults to continue to be engaged and contribute to the life of their community for the longest possible time, communities need to improve neighborhood safety and design, increase the accessible, affordable housing stock and reduce environmental hazards.

"In public health, we encourage older adults to get out and walk—but they are at increased risk as pedestrians from falls or injury from motor vehicles," said Hunter. In fact, an older adult is 60 percent more likely to die if hit by a car, according to data shared by Leary. Older adults need places to rest, access to rest rooms and roadways that are safe for pedestrians, as well as safe, well-lit, crime-free neighborhoods.

Hunter offered the example of North Carolina’s Walk Wise, Drive Smart campaign in a community of 11,000—nearly a third of whom were over the age of 65. The town conducted community education, increased law enforcement and strategically re-engineered community infrastructure, targeted to areas with the highest proportion of older adults and taking into account the routes they’d need to travel to get fresh food, opportunities for social interaction and access to medical care. Through this program they created a safer, more inviting environment for older adults—knowing, in the end, this would benefit the entire community as well.

The City of Citrus Heights, California (population 88,000) is another example of a resident-driven approach to improved walkability. Joan Twiss of the Center for Civic Partnerships described how, with a small grant from the Center, the City reached out through its neighborhood associations to conduct a survey and do walkability audits among its older adults and people with disabilities. As a result, the City completed multiple sidewalk in-fills, upgraded intersections and installed barriers for a safer walking environment. A Safe Routes to School grant will link a park, schools and a commercial corridor. "This is a great example of how engaging the community can make walkability both a community norm and a priority within city hall," said Twiss.

Leary emphasized the importance of designing communities and transit options so older adults can stay mobile. "Transport helps us get to everywhere that matters to us," said Leary. "When someone can no longer drive, it can cause depression. We’re a driving-centric society and we need to redefine mobility."

The evidence for the link between transportation and health is building.

"We’re starting to see a direct relationship between hospital readmissions and lack of transportation options," said Leary. "We’re even starting to see that people won’t make preventive care appointments if they don’t have good transportation options."

So what can we do about it? Build communities with integrated land use arrangements and transit-oriented development, broker joint use agreements so community facilities like schools can be available to older adults, design complete streets and institute volunteer driver laws.

And how do we do that? BORPSAT, said Leary—get a "Bunch of the Right People Sitting Around the Table." It will be critical to partner across sectors, including public health, city planning, transportation and housing.

"The things we recognize now recognize are the major drivers of health are things that are in other sectors' 'lanes.' The decisions they make have an enormous impact on health," said Chris Kochtitzky, Division of Emergency and Environmental Health Services at the CDC.

One way make sure health is taken into account with community decisions is to employ health impact assessments.

But public health needs to be one of many perspectives at that BORPSAT table. Kochtitzky shared the example of success in West Wabasso, Fla. The community had twice the rate of seniors age 65 and older when compared to the rest of the nation, and the median annual income was $652. The community was comprised mainly of retired citrus workers.

They got the community engaged to prioritize the things that were important to them. The number one issue that came up: street lights. It cost the community a mere $17,000 to install street lights in key spots, and that small investment made a huge difference. "If public health came in and said heart disease and diabetes were the major problems, we would have ended up with a public education campaign," said Kochtitzky. "This way they ended up with street lights and walking trails, and a community everyone could participate in."

Helpful resources include:

This commentary originally appeared on the RWJF New Public Health blog.