Local Government Adoption of Aging-Friendly Policies and Programs: A Mixed Methods Approach

In recent years a growing number of international, national, state, and local initiatives have started working to make existing communities more aging friendly. This interest in changing the physical and social environment of existing communities to improve the health and well-being of older adults and help them age in place is a reaction to a confluence of factors, including the aging of the U.S. population, a projected increase in disability and chronic disease in future cohorts of older adults, and an inadequate long-term care system. Aging-friendly communities share three characteristics: 1) individuals can continue to pursue and enjoy interests and activities, 2) supports are available so that individuals with functional disabilities can still meet their basic health and social needs, and 3) older adults can develop new sources of fulfillment and engagement (Lehning, Chun, & Scharlach, 2007). Framed by an internal determinants and diffusion model, this study uses a sequential explanatory mixed methods research design to explore 1) the extent to which 101 cities in 9 counties in a geographically and economically diverse metropolitan area have adopted aging-friendly policies, programs, and infrastructure changes in the areas of community design, housing, transportation, health care and supportive services, and opportunities for community engagement, and 2) the diffusion factors, community characteristics, and government characteristics associated with such adoption. The researcher collected and analyzed quantitative and qualitative data from four types of respondents: city planners/community development directors, directors of county adult and aging services, county transportation authority employees, and public transit officials. In the quantitative phase, the researcher combined primary data collected via online surveys with secondary data from the 2000 U.S. Census and the 2000 California Cities Annual Report. In the qualitative phase, a subsample of 18 survey respondents participated in open-ended telephone interviews to provide a more in-depth understanding of the process of the adoption of aging-friendly innovations and expand on the quantitative findings. For the first research question, the most common aging-friendly innovations adopted by local governments include those that target alternative forms of mobility, including incentives for mixed use neighborhoods, infrastructure changes to improve walkability, discounted public transportation fares, and changes to improve accessibility of public transit. The least common policies and programs are those that aim to help older adults continue driving and those that provide incentives to develop accessible new housing for older adults. For the second research question, bivariate analyses of city-level data provide partial support for an internal determinants and diffusion model. Cities with a larger total population, larger percent of the population with a disability, and have experienced public pressure or individual advocacy for aging-friendly innovations adopted more aging-friendly policies, programs, and infrastructure changes. Contrary to hypotheses, cities with higher population educational attainment, higher median household income, and a larger proportion of the population age 65 and older adopted fewer aging-friendly innovations. Qualitative interviews offered potential explanations for these results. First, disability groups may be more active than older adults in terms of advocating for the adoption of certain aging-friendly innovations, such as accessible housing and walkable neighborhoods. Second, communities whose population enjoys a higher socioeconomic status may not perceive a strong role for local government in terms of creating more aging-friendly communities, and these residents may get their needs met through nongovernmental sources. Third, while there was no significant association between per capita government spending and the adoption of aging-friendly innovations, interviews suggest that funding plays an important role, and perhaps grant funding, slack resources, and recent increases or decreases in local government financial resources are a better measure of this factor. Finally, qualitative interviews indicate that future studies should explore additional factors, including communication, collaboration, and state and federal mandates. The findings of this study suggest a number of research and practice implications that should be further explored in future research. First, the results and limitations of this research suggest that it should be replicated to determine whether the findings explain local government adoption of aging-friendly innovations in general or are specific to the population and methods used in this study. This replication should not only expand the sample size and explore the generalizability of findings to other geographic regions, but use a modified internal determinants and diffusion model that takes into account findings of the present study. Second, given the limitations of the current study, results offer a number of strategies that residents, advocates, service providers, and policymakers could employ in their efforts to create more aging-friendly communities. These strategies include mobilizing public support of and pressure for aging-friendly innovations, targeting advocacy efforts at individuals working within government who could become policy entrepreneurs, and working towards vertical diffusion of innovations via state and federal mandates and funding. Finally, survey and interview results hint at additional lines of inquiry that should be pursued as part of a larger aging-friendly communities research agenda. First, what exactly is an aging-friendly innovation or an aging-friendly community? Second, how can communities change their physical and social environment in such a way that the needs and wants of older residents do not impede those of other residents? Finally, and perhaps most importantly, what impact do these policies, programs, and infrastructure changes on the health and well-being of older adults and their ability to age in place?