Cities Not Fit for Ageing Populations 

25/10/2019

(graphic: BWPI)

barrySays

The Hong Kong Institute of Urban Design has spent the last two years in researching and assessing the suitability of Hong Kong’s urban environment in encouraging active urban ageing and in identifying actions and interventions that could lead to significant improvements towards meeting the basic needs of an increasing elderly population.​

KEYWORDS

Active-Ageing; Experiential; Empathy; Barriers; Affordances

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This article was first published in Urban Design Journal


http://urbanism.com.cn/EN/volumn/volumn_4263.shtml

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INTRODUCTION

Along with China’s one child policy, the demographic shift caused by ageing populations in developed economies has been exacerbated by the global trend to urbanisation. The challenge of providing adequate urban elderly care has become pressing, yet the focus up to now has primarily been on providing adequate elderly residential facilities, whereas the frequently presented preference for ‘ageing in place’ coupled with a clear necessity for increased ‘care in the community’ that addresses the shortfall in public healthcare support, has in fact positioned the wider urban public realm as the critical battleground for support of the aged.

THE WARNING SIGNS

2016 Population By-census-Graphic Guide. Image: Census and Statistics Department, Hong Kong Special Administrative Region

Actions For Active Ageing

In recent years the Hong Kong Institute of Urban Design has become increasingly aware of the severe problems facing the urban environment in meeting the needs of the ageing population. This was brought to a stark warning in early 2017 when the government results of the Census and Statistics Department’s 2016 by-census (HKSAR Government 2017), showed that the median age of the population had increased to 43.4 years, from 39.6 ten years previous. The proportion aged 65 or older had increased from 12 per cent of the population in 2006 to a new high of 16 per cent. In 1986 the figure was just 8 per cent. The ageing of society is a very gradual process, which makes it hard to notice, however if we now look forward just another 20 years, the difference becomes critically apparent, with the number of people aged over 65 having gone up to a massive 31.1 per cent of Hong Kong’s population (Census & Statistics Department 2017).

Image: HKIUD

Already concerned about the poor urban environment found in terms of universal access and environmental health within the city, the Institute decided to focus its attention to evaluation of the urban realm in the eyes of its existing ageing population in an effort to prioritise both thinking and funding towards what would be needed to start to better futureproof both public and private capital works projects. A three-pronged approach was conceived in which firstly research would be undertaken that would be available as a focus for discussion at the 2018 HKIUD Conference ‘Actions for Active Ageing – Urban Design for All’. The final post conference stage would be to reach clear actions and objectives in terms of kickstarting a pilot project addressing the key urban design factors that would enable an ageing population to remain active, healthy and engaged, thereby continuing to contribute society, the community and reduce burdens of care.

HKIUD Conference 2018. Image: HKIUD

Active Ageing Award for HKIUD 

The Institute continues to explore both the physical and social issues of how our cities can be more inclusive and why better urban design is essential in reinforcing the cultural ties in our communities, especially with an ageing population, including ideas of walkability, active living environment, transport modes, social participation, healthcare and mixed-use development. Through its active ageing research, it has the following aims: -

• outline the key aspects of the different “software” and “hardware” sides to excellent and inclusive urban design – e.g. from policy, walkability, housing, etc. perspectives.
• explore how best-practice case studies from innovative projects all over the world can be applied to our city;
• identify what will be needed, in specific policy and urban design terms, to effectively serve the ageing population in Hong Kong;
• influence how the government plans for the city to adapt to the rapid ageing population growth; and
• highlight the opportunities and challenges professionals in the industry will face going forward.

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GETTING SOME FACTS

Ageing in the Hong Kong Urban Environment - An Experiential Workshop. Image: HKIUD

Image:HKIUD

“Ageing in the Hong Kong Urban Environment - An Experiential Workshop” was initially held in March 2018 as a major pre-conference research event jointly organised by HKIUD, P&T Group and Hong Kong Sheng Kung Hui Welfare Council (SKHWC). The workshop received support from approximately 40  targeted participants, including Ms. Bernadette Linn (Permanent Secretary for Development - Planning & Lands), Mr. Tony Tse (Member of the Legislative Council for Architectural, Surveying, Planning and Landscape), Mrs. Sylvia Lam (Director of Architectural Services Department), Mr. Raymond Lee ( Director of Planning Department), Ms. Alice Wan (Member of the Board of Directors, Southern District Healthy & Safe Association Limited) and Mrs. Susanne Wong (District Officer of Central and Western). 

Image:HKIUD

Participants were able to “gear up” with an ‘elderly simulation suit’ provided by Eldpathy HK, an organisation that encourages participation in elderly philanthropy through experiential programmes. The suit, which is a patented invention of the Cycling & Health Technology Industry R & D Center (CHC) in Taiwan has been developed by professionals including doctors, nurses, physiologists, and social workers it consists of several specially designed impediments such as weights, braces, elastic band restraints and a pair of blurry eyeglasses, which allows participants to feel how the aged bend their bodies and grasp the physical experiences of an elderly person. With the assistance of volunteers, participants were engaged in a number of typical outdoor daily life elderly activities in Western District, for example, visiting Western District Elderly Community Centre, trying out the community facilities and fitness equipment for the elderly in a park, and eventually experiencing different real-life hardships faced by the elderly. ​

Image:HKIUD

A key part of undertaking the research was to build up a data set that could highlight priorities in terms of identifying the key barriers and affordances to elderly urban activity. An online survey was developed which was undertaken by the workshop participants both before wearing the elderly simulation suit and following the exercise, the object being to gauge any change in perception between undertaking tasks in their current physical state compared with that of what they might expect in years going forward. Not only do participants get to understand how their physical condition will deteriorate in future years and recognise the difficulties associated with that, they are also able to better empathise with seniors in the community. Nearly everyone has elderly family or friends that need to be looked after, bringing a very personal relevance and perspective to the exercise.

Ageing Experience Workshop #2

Image:HKIUD

A second workshop was subsequently held in September 2018 with participants comprised of students from Chinese University Hong Kong, Tsinghua University and Stanford University as a means to both educate tomorrow’s urban designers and at the same time collect further data from a contrasting and youthful user group. The data currently shared here is based on the surveys undertaken during the First and Second Experiential workshops as well as that from the ongoing online survey on Facebook which acts as a control group representing the public perception of those who have not had the benefit of having experienced the simulation suit. ​

So how can urban design in Hong Kong be more inclusive and enable the elderly to stay active, independent and remain healthy longer which is the overall challenge of active ageing? Do designers and policy makers have a full understanding of the difficulties faced by the elderly? ​

ITS OFFICIAL, WE NEED MORE TOILETS

Image: HKIUD

Image: HKIUD

The survey outlines a whole host of important issues needed for improvements in the urban environment, where many are simple and obvious to most it would seem. For instance, all three groups similarly identify “Staying Active for Better Health, Freedom and Ability to Go Places” as the most important issue for the elderly to be “happy and well”.   ​

​When the question is asked “How Well Does Our Urban Environment Support Active Ageing?” however a distinct differential can be identified between the public general perception and the considerations of those who have actively worn the simulation suit. Whilst both the “selected” and “student” participants of the first and second experiential workshops showed consistent results, with roughly two thirds finding the environment “not really” suitable to active ageing, a much more positive perspective is provided by the general public where almost half consider the environment acceptable. This is backed up by the results of the survey undertaken by the 1st workshop participants BEFORE they undertook the experiential workshop. The suggestion exists therefore that the problems of the elderly are not properly recognized.

The third area of the survey tries to identify what makes an elderly-friendly urban environment, where a comfortable walking environment and convenient transport connections are paramount to all survey groups. The importance of having barrier free access and rest points are also highlighted consistently across groups. The study identified the key elements that shape an elderly-friendly urban environment by dividing them into four subsets: -

• Safe Infrastructure
• Supportive Amenities
• Cognitive Power
• Well-being factors

Image: HKIUD

When it comes to the provision of safe infrastructure, factors such as road crossing, narrow footpath widths, presence of obstacles and steepness of gradients have a greater importance to the experiential groups than the public perception, whilst the presence of steps and uneven surfaces is considered the greatest urban safety hazard across all sectors. Solving such problems with wider pavements and providing handrails is clearly substantiated whilst supportive amenities highlight the need for more regular provision of toilets and seats as a means to reducing the barrier of having to walk long distances.

When it comes to cognition and the ability of navigating the urban environment, the experience of the 1st workshop group was profound. After undertaking the experiential workshop, a significant increase was observed in numbers finding it “difficult to find new places” which would constitute a strong deterrent to actively engaging in the unfamiliar, widening the activity base or being required to attend unfamiliar locations. At the end of the day, maintaining connections with the community and having easily accessible places for a wide variety of activities in well maintained and appropriate facilities is what makes the elderly most happy in the urban setting. ​

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DOES IT REALLY MATTER?

As many developed countries move towards the problems of ageing populations, making our cities more age enabled to all sectors of society becomes essential. Being active through ageing is important and accessibility to quality landscape areas in particular makes it easy and enjoyable to get out on foot. Uneven paving, steps, a lack of rest opportunities or insufficient toilet provision can all act as barriers to elderly wanting to take a walk whereas access to daylight, the natural environment and sociable places act as affordances. It’s the challenge of the journey from the home to the destination that has a key impact on decision making. Just one thing wrong or difficult can stop elderly getting out and about, so the design of the physical environment is critically important. Details such as having arms on seats to help get up or down and choosing materials that don’t get too hot or cold can make a huge difference (Ward Thompson 2018).

In better understanding the issues of keeping active it is noteworthy that people are simply more likely to walk if they are outside rather than being indoors. Getting outside can also help to avoid social isolation and the resultant problems of loneliness and mental health. The body also needs vitamin ‘D’ through sunlight and daylight can affect our circadian rhythms and impact sleep quality. Technology providing a ‘virtual and artificial landscape’ can never replace the real thing. Better pedestrian environments, which are pleasant, shaded and can activate the senses by hearing birdsong, smelling flowers, and enjoying the change of weather and season are important (Ward Thompson 2018).

Barriers and Affordances to Active Ageing

The WHO recommends better design of the built environment to create age-friendly cities that support public health into old age. (World Health Organisation 2007) Public health is something that needs to work across all sectors and all environments and investment in the urban realm as a public health tool is extremely low in cost and high in benefit compared to intensive corrective public medical costs. It takes a long time however to fully measure and witness the return on investment to society at large of quality urban design provision and of its recurrent maintenance cost; perhaps even decades. The Hong Kong Institute of urban Design hopes to be able to use the data being collected to convince policy makers and funding bodies of the real and valuable benefits that can be accrued from well considered universal urban design environments, having identified the importance, not just of providing a variety of diverse facilities within neighbourhoods, but also supporting ease of access to them, as the key to maintaining active urban ageing. It hopes to continue to engage both young and elderly generations in public decision making on active ageing issues.
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Barry Wilson is an Urban Designer, Landscape Architect, part time professor, public speaker, writer, climate reality leader and advocate for change.

Barry Wilson Project Initiatives Ltd have been tackling urbanisation issues in Hong Kong and China for over 20 years. (www.initiatives.com.hk). 

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References:

[1]Census & Statistics Department, HKSAR Government. Hong Kong population projections for 2017- 2066[EB/OL]. [2019-04-15]. https://www.censtatd.gov. hk/press_release/pressReleaseDetail.jsp?charsetID=1&- pressRID=4200.

[2]HKSAR Government. Census and Statistics Department for the 2016 Population By-census[EB/OL]. [2019- 04-15]. https://www.bycensus2016.gov.hk/en/index.html.

[3]Ward Thompson, Catharine. 2018. An Ecology of Urban Spaces. 26 September[EB/OL]. [2019-04-15]. http:// www.initiatives.com.hk/180926-an-ecology-of-urbanspaces.html.

[4]Suar D. Global age-friendly cities: A guide[J]. Indian Journal of Medical Research, 2008, 127(5): 507-509.