The magazine of the UW School of Public Health

engAGE in Community

Deborah John and Kathy Gunter

By 2025, one in four Oregonians will be 65 years or older, giving Oregon the fourth highest proportion of “seniors” in the nation. Recent projections indicate that Clackamas County, a rural county that includes a portion of the Portland metropolitan area, is one of nine Oregon Counties where the population of adults aged 75 and older is expected to at least double by 2040. The majority of older adults want to age in-place. They report a desire to continue living in their own residences and communities, a preference that may burden the resources of families and municipalities. 

engAGE in Community is a “campus-community” action partnership among Oregon State University’s (OSU) Extension Family and Community Health, Clackamas County Social Services, and AARP Oregon. engAGE was formed with the aim of creating an “age-friendly” Clackamas County. 

The concept of “age-friendly” originated from the World Health Organization’s (WHO) 2007 Global Age-Friendly Cities project. The initial research for this project took place in urban cities and involved significant discussion with older urban residents, including those from Portland, Oregon.  The resultant model operationalized the definition of an age-friendly community as a place where “service providers, public officials, community leaders, faith leaders, business people, and citizens recognize the great diversity among older persons, promote their inclusion and contribution in all areas of community life, respect their decisions and lifestyle choices, and anticipate and respond flexibly to aging-related needs and preferences" through focused physical, social, and service environmental supports.

The WHO’s age-friendly model is the theoretical framework for engAGE in Community. The WHO model categorizes the topical features of age-friendly places into eight observable focus areas: transportation, housing, outdoor spaces and buildings, social participation, respect and inclusion, civic engagement and employment, community and health services, and communications and information. The research team organized these eight focus areas into three environmental categories—physical, social, and service—and gathered information from Clackamas County residents about the environmental attributes of their local communities that support or hinder older adults’ lifestyle choices and participation in all aspects of community life.

Mapping Attributes: Participatory Photographic Surveys (MAPPS)

To collect information about actual community features, researchers recruited, trained, and deployed middle-aged and older adult residents as well as representatives from sectors that included transportation, housing, and health. The local engAGE MAPPS teams were trained to map attributes of their community using participatory photographic surveys. The MAPPS method integrates community participatory photomapping using global positioning system (GPS) technology and photography with residents’ voiced experiences of their community environments to explore, understand, and improve community livability. MAPPS is an engagement, assessment, and action tool that can be applied to a variety of public health problems where understanding the interaction of people and places is essential to developing locally relevant solutions.

engAGE MAPPS Factors and Findings

For a year, five Clackamas County communities—Hoodland, Canby, Wilsonville, Oregon City, and Damascus—participated in engAGE MAPPS projects. From these communities, 53 volunteers contributed to MAPPS assessments by individually photographing and geocoding (i.e. mapping) the features of their communities perceived as either supporting or hindering place-based aging for community residents.

More than 530 community features were photomapped. Qualitative data from all sources were analyzed, organized according to an "age-friendly" model, and provided back to each community in the form of a report that identified areas for improvements and resident-informed solutions. Approximately 185 older and middle-aged adult residents and sector stakeholders participated in public conversations about the physical, social, and service attributes of their community places within Clackamas County. MAPPS activities led to local consensus building, coalition development, advocacy, and action planning to improve the county’s age-friendliness.

Physical Environment

The physical environment in Clackamas County is rich with natural and built amenities that both support and challenge age-friendliness. During community conversations, the most frequently discussed built environment features were transportation and housing. In these areas, perceived barriers outweighed supports. Walkability, including pedestrian safety and accessibility, was the most frequently discussed concern related to outdoor spaces and buildings.

Across Clackamas County, the resident-generated maps reflected a strong dependence on personal automobiles to access healthy aging resources. Some communities had active transportation (e.g., walking/bicycling) and/or public transit options but with gaps in connectivity and/or low use. When faced with the inability to drive one’s self, older residents encountered less-than-optimal choices or a lack of viable transportation options.

The lack of transit options makes aging in-place more difficult in Clackamas County. While a large majority of older residents live in their own homes, participants agreed that accessible and affordable housing and assisted living options are important community features. A shared perception was that inadequate housing options negatively influenced livability and "disturbed" family connections and social networks for the resident with changing housing requirements. Community conversations revealed a common desire to improve accessibility of outdoor spaces and walkability to promote active aging and personal mobility, social and cultural participation, and community vitality.

Sociocultural and Service Environments

Though community members expressed a desire to have more social opportunities, Clackamas County is supported with adult community centers, restaurants, theaters, faith groups, and music venues. While "community" emerged as a strong supporting attribute for age-friendliness, respectful, inclusive, and intergenerational social and cultural participation and civic engagement opportunities were frequently identified as areas needing improvement. With regard to the service environment (i.e. community and health services, communications and information), Clackamas County seems adequately resourced. However, people in smaller, rural communities and unincorporated areas of the county exposed critical gaps in availability of community services to support health and independent living and acknowledged more barriers than supports for aging-in-place compared to residents living in non-rural places and municipalities.

Why engAGE MAPPS?

engAGE MAPPS was designed to help people explore and strengthen their healthy aging networks, environments and policies, as well as to communicate diverse perspectives and experiences among community members and key decision-makers. MAPPS helped residents to uncover the environmental supports and barriers they encounter as they navigate community life and enact their activities of daily living. Engaging local people in open dialogue raised awareness of different perceptions of their community as age-friendly. MAPPS made public people’s personal experience of interacting with community features, involved community members in the process from beginning to end, publicized the issues, and promoted the use of findings to effect change.

Authors

Deborah John, PhD, is an Assistant Professor in the School of Biological and Population Health Sciences at Oregon State University. 

Kathy Gunter, PhD, is an Assistant Professor in the School of Biological and Population Health Sciences at Oregon State University.

Resources

  1. Centers for Disease Control and Prevention and The Merck Company Foundation. The state of aging and health in America 2007. Washington, DC: 2007. 46p. Available from http://www.cdc.gov/aging/
  2. Dennis S Jr, Gaulocher S, Carpiano R, Brown D. Participatory photo mapping (PPM): exploring an integrated method for health and place research with young people. Health Place. 2009 Jun, 15(2):466-73. Available from  http://www.ncbi.nlm.nih.gov/pubmed/18930431
  3. Farber N, Shingle D. Aging in place: a state survey of livability policies and practices. Washington, DC: AARP Public Policy Institute (US); 2011 Dec. 84 p. ISBN 978-1-58024—645-3. Available from http://www.aarp.org/home-garden/livable-communities/info-11-2011/Aging-In-Place.html
  4. Oregon Department of Human Services and Oregon Health and Science University. Healthy aging in Oregon counties report. Portland (OR) 2009. 84 p. Available from http://www.oregon.gov/DHS/spwpd/sua/hlthy-aging.shtml
  5. World Health Organization. Global age-friendly cities: a guide. Geneva (CH) 2007. 82 p. Available from http://www.who.int/ageing/publications/Global_age_friendly_cities_Guide_English.pdf