Socially active neighbourhoods for older adults : consolidation of evidence from psychometric tests and cross-sectional studies

Introduction – This thesis compiles studies undertaken in the field of environmental gerontology, with emphasis on the role of the built environment in 'ageing in context', a global initiative promoting the ideal for individuals to age well in their neighbourhoods and homes. The provision of Socially Active Neighbourhoods (SAN), which is defined in this thesis as communities that support social activity among community-dwelling older adults, is a potential way to achieve ageing in place goals. The Studies – This thesis brings together 11 papers that focused on: (1) the construction of scales measuring SAN and other factors relevant to social activity in older adults; (2) an assessment of the relationship between the built environment, personal factors, active behaviours (i.e. social activity, physical activity (PA)), and self-reported health, and (3) a contextual analysis of other factors (e.g. active social networks, physical function, education) that may affect the utilization of SAN. Cross-sectional designs (7 studies), a mixed approach comprising the cross-sectional and phenomenological qualitative designs (2 studies), and comprehensive literature review (2 studies) were employed to conduct the studies. The setting of all studies was Accra, Ghana, where predominantly older adults aged 60 years or more served as participants. Only three studies (Papers 2, 10, and 11) involved the general population. Participants were selected based on selection criteria determined based on ethics committee suggestions, the Helsinki research ethics declaration, and power calculation. To achieve sufficient statistical power, sample sizes ≥500 were used. Contribution – This thesis contributes to an improved understanding of key ageing theories that are often used alongside person-environment fit models. It also provides a comprehensive guide that researchers in gerontology and other fields can apply to select study participants and identify potential confounding variables based on relevant theories. Furthermore, psychometric tools measuring SAN and other built environment factors relevant to social activity are provided. These unique scales would encourage research work evaluating SAN, serve as neighbourhood audit tools in Ghana, and provide a basis for developing similar tools in other countries. By its cross-sectional studies, this thesis for the first time reports the roles of ‘active social networks’ and ‘sedentary social networks’ in ageing in context and the utilization of SAN. Similarly, a better method for measuring sedentary time in older adults is tested and reported; this new method is a potential improvement to the traditional single-item method associated with the Global Physical Activity Questionnaire (GPAQ) and International Physical Activity Questionnaire (IPAQ). This thesis also unfolds clinical PA counselling as a possible way to enable older adults to successfully maintain active behaviours over time and age in place. Finally, the thesis identifies the need for infectious diseases to be seen as contextual factors that can discourage the utilization of SAN by older adults and conscientizes stakeholders to address epidemics as a potential impediment to ageing in place.