Issue 3 / Age In Place

How civic design
can promote
healthy aging

For many of us, a walk around the corner or a trip to the store is an effortless fact of daily life.

But viewed through the eyes of an older adult with restricted mobility, that same trip can be an intimidating, physically demanding ordeal. Simple details of the urban landscape, such as uneven pavement or crosswalk timing, become harrowing obstacles to those individuals with physical limitations that make walking difficult or induce fear of falling.

The all-too-frequent result is that older adults are deterred from engaging with their communities to the detriment of their physical and social well-being. So what makes a community a good place to grow old?

That’s the overarching question that inspires MSFHR Scholars Joanie Sims-Gould and Heather McKay. For years, the Centre for Hip Health and Mobility researchers have been working at ground level throughout Lower Mainland communities to understand the unique issues facing older adults. Through their work, they have built an evidence base that is helping to change the way engineers, city planners, and policy-makers look at older adults and the way cities are designed.

Chapter 1:

Taking it to the Streets

How street-level changes impact mobility and social interaction


Taking a walk along the Comox Greenway in Vancouver’s West End is like wandering into an urban oasis.

Benches and chairs dot the sidewalk at half-block intervals offering a scenic respite, often accompanied by the refreshment of a water fountain. Cyclists zip past in both directions, outnumbering cars by a hefty margin along the traffic-calmed thoroughfare. Well-maintained sidewalks and ample shade make for a pleasant stroll up or down the gentle slope.

It is, by any reasonable measure, a walker’s paradise and many of its defining features reflect evidence and perspectives shared with planners by McKay and Sims-Gould. The $5.4-million project, completed in June 2013, takes to heart the lessons learned from their extensive and ongoing study of older adults’ mobility needs, providing a model for the development of other neighbourhoods to better support healthy aging.

Through a number of research projects – including Active Streets, Active People (ASAP), funded by MSFHR and the Wall Solutions Initiative – McKay, Sims-Gould, and colleagues approached the Comox Greenway development as a “natural experiment” to study the influence of street-level changes on mobility and social interaction. Their consultations with older adults have ranged from on-the-ground neighbourhood audits to face-to-face conversations about the features that support or hinder mobility.

What they found was that basic features that might an able-bodied person might overlook – benches, lighting, smooth sidewalks, safer crosswalks – mattered greatly to older adults and were strongly connected to the ability to age with independence and autonomy.

“If you create an urban environment that has features that facilitate getting out the door, we see much greater incidence of people using active modes of transportation,” says Sims-Gould. “And what does that mean? That means that they’re obviously reaping the physical health benefits but also are more likely to come in contact with their neighbours, make social connections.”

Sims-Gould notes that their research found older adults living near the greenway chose to use active modes of transportation – primarily walking – roughly two-thirds of the time. Region-wide, the opposite is true, with 66% of older adults relying on cars.

  • To help understand the connections between mobility, social connectedness, and neighbourhood environments, researchers at the Centre for Hip Health & Mobility (CHHM) organized community engagement events, including walking tours.
  • The “Walk in My Shoes” event, held in May 2012, brought together older residents of Vancouver’s West End, CHHM researchers, and City of Vancouver planning and engineering staff.
  • Using a checklist provided by the researchers, participants set out to identify features of Vancouver’s West End that either supported or inhibited older adult mobility.
  • Participants provided valuable first-hand feedback on the mobility impact of neighbourhood features such as parks, street crossings, sidewalks, lighting, benches, and proximity to services.
  • The event highlighted the important role of community participation in the research process. Findings from the event were shared with local, national, and international stakeholders to assist communities in planning for an aging population. A summary report is available for download.
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The two were invited by the City of Vancouver to consult on the greenway project, where they shared with planners not just the substance of their findings but also, critically, their methods. “How that design played out was really based on us providing – well, Joanie particularly – providing input and guiding them on, first of all, how do you engage older adults in the consultation process?” says McKay. “ And then understanding based on our research and our knowledge base what the needs are for them.”

While it represents a vital step towards greater awareness of older adults in urban planning, the Comox Greenway remains an exception to the rule. Many neighbourhoods, particularly those in suburban settings, remain tailored to car-based transportation. The challenge facing researchers is how to use evidence to ensure older adults have an ongoing voice at the planning table.

“People know what they need in their neighbourhoods and what works – the key is tapping into this knowledge and ensuring it is heard, shared, and communicated,” says Sims-Gould.

Chapter 2:

Beginning with the End in Mind

Understanding the relationships that transform research into action


There is a clear need for research that responds to policy priorities, but this can mean little if policy is not also responsive to research.

“It’s the last line of every grant: ‘…and we influenced policy,’” explains McKay. “But it’s actually very, very difficult to do that.”

The secret to real-world impact, she says, is relationship building.

We talk about beginning with the end in mind. So, if at the end of any project you want to have impact, if you want to roll your research out and implement it directly in the need those people at the table really early on who are going to be the vehicles who allow you to do that.

British Columbia has the fastest-growing population of seniors in Canada. The BC Ministry of Health has identified healthy aging as an important priority in its Seniors Action Plan.

First and foremost, these relationships help researchers understand how to ask and answer the questions that matter.

Strong relationships also help ensure the research perspective is represented when decisions are being made. In addition to their work on the Comox Greenway, the two researchers have earned a place on several working groups focused on mobility and liveability. McKay currently co-chairs the provincial Physical Activity Strategy leadership council and is a member of the City of Vancouver’s “A Healthy City for All” leadership table. Sims-Gould leads a provincial physical activity strategy for older adults and was invited to meetings hosted by the City of Vancouver around the 2012 Velo-City conference.

Proactively building these relationships over the course of more than a decade has clearly benefitted their research.

“You can invest a lot of time up front in building relationships with people, and then when you need to do something it’s relatively easy,” says Sims-Gould.

Chapter 3:

Finding Our Voice

How interdisciplinary teams develop a common language


At the core of all good relationships is mutual understanding. Researchers, planners, and engineers approach their jobs very differently, and the competing priorities and terminologies can pose a challenge to meaningful collaboration.

“We don’t pretend we can walk into a room of urban planners and necessarily speak that language,” says McKay. “It’s about finding a common language really early on in order to be able to get to the same place.”

For McKay and Sims-Gould, the ability to develop a common language with city planners, engineers, government officials, and older adults has been elevated by their work with knowledge broker Callista Haggis. Jointly funded by MSFHR and the Wall Solutions Initiative, Haggis has been at the forefront of sustaining a two-way dialogue between the research team and community partners.

“Having a dedicated knowledge broker on the team funded through Michael Smith really allowed us to have a focused strategy of how, when, and where we wanted our research evidence to affect communities,” says Haggis.

Armed with a skill set that includes interactive approaches to communication, Haggis has led the way in developing novel strategies for sharing the team’s research. The boldest project by far has been the production of I’d Rather Stay, a 19-minute documentary film that brings the findings of Active Streets, Active People to life through the personal stories of five older adults living in the Lower Mainland.

It was the search for common language and clear communication that prompted the film’s production. In speaking with partners at the City of Vancouver, Haggis says, it became clear that the last thing the planners wanted was another toolkit, another lengthy report.

Our research team was great because they realized that maybe these modes of communication are outdated and we both need to adapt to new technologies but also recognize that lots of people are visual learners, lots of people are emotional learners, says Haggis.

Documentary video, she notes, is an effective way of visualizing the themes of academic research and using personal stories to carry the message. Working with cinematographer Farzine MacRae, Haggis set out to translate the team’s research into a story that would resonate with a wider audience.

Completed in 2014, I’d Rather Stay has screened at four international film festivals around North America and recently won “Best of Fest” at the 2015 New Urbanism Film Festival in Los Angeles. The film has also been screened at six community forums and shown privately to planners and government officials more than a dozen times.

As a vehicle for finding a common language, the film has been a resounding success. Following one community screening, the mayor of a Greater Vancouver municipality was taken aback that his government had not considered the impact of crosswalk timing on older people. He committed on the spot to ordering a review of all the crosswalk light timings at major intersections in his city, says Sims-Gould.

At another screening, the residents of an apartment building were inspired to set up a skills exchange to help their older neighbours accomplish routine tasks that would allow them to stay in their homes.

The common language forged through strong relationships and tools like I’d Rather Stay has been one of the research team’s greatest impacts. While they hesitate to claim sweeping policy changes, they take justifiable pride in helping engineers, planners, and decision-makers think differently about the unique needs of older people.

Chapter 4:

Informing a Healthy Future

Research must shape our response to health priorities


Through the relationships they have built and the common language they have forged, McKay, Sims-Gould, and Haggis offer a model for responsive research.

As researchers working in a domain that directly impacts the design of our cities, they have made a concerted effort to ensure their research is asking the right questions.

“My first few conversations with government were, ‘How can we help you? Here’s what we do. Tell me how what we do can help you meet your needs,’” says McKay.

Just as importantly, their ongoing efforts to understand the needs of older adults have grounded their work in the realities of daily life facing this population. And by recognizing the valuable opportunities presented by the knowledge broker role, they have shown how creative approaches to sharing evidence can help break down the barriers between academics, policy-makers, and the public.

As outlined in the Foundation’s strategic plan, MSFHR is committed to supporting teams to conduct and apply research that addresses issues affecting BC’s health system.

MSFHR has been responsive to BC health priorities since its inception through targeted funding for projects such as the Health Services and Policy Research Support Network and the BC Nursing Research Initiative. More recently, the BC government has identified healthy aging as a priority area, and MSFHR is helping to meet research needs in seniors’ home and community care.

Faced with a rapidly aging population, it is vital that our society provides greater support in the coming years and decades for seniors to age in place. As part of this issue of Spark, we profile several MSFHR-supported projects that are helping to address this priority: