How do you remake a city to be 'age friendly'?

A World Living Longer: Global aging is one of the greatest challenges of the century. And this is not just a “Western” problem. Politicians and policy makers around the world are rethinking healthcare networks, urban design, nursing care, and pension systems to prepare for it. The elderly themselves are key players to help turn this from challenge to opportunity.

For more in the Monitor's look at global aging issues and solutions, please visit our series homepage.

They are called the “graffiti grannies.”

Clutching canisters of green spray paint, a group of pensioners in Manchester takes to the streets and marks every pothole or uneven sidewalk that might be treacherous, and then challenges the city council to bring in the pavers. 

The activism of the year-old group, officially named the Levenshulme Inspired Task Force, doesn’t stop there. When an elderly man in a wheelchair wet himself after several shopkeepers on the city's main street refused his requests to use the bathroom, members of the group launched the “Caught Short” campaign. Some in their 80s, they knocked on dozens of shopkeepers’ doors and asked who would say "no" next time. They then published a leaflet, essentially a “where-to-go” guide complete with information on wheelchair accessibility.

“We want to do everything to make this community more age-friendly,” says Joanne Wilcock, who knows the streets well since she navigates them daily in her wheelchair. 

Manchester, in the north of England, is better known for a post-industrial makeover that has drawn the young and hip. But it is also leading the way in adapting the city for its senior citizens – and garnering attention worldwide in doing so. Cities are now facing the pressing issue of reconsidering the design, housing, transport, and health services for populations that are quickly aging.

Manchester has been at the forefront of empowering older people themselves as the agents of change – relying on their on-the-ground expertise, and battling ageism, loneliness, and soaring costs in the process. 

“Around the world populations are aging, more people are living in cities, and these are accompanied by other demographic changes – increased women in the workforce, migration towards cities and hence children living away from their parents. All of these demographic changes have huge implications for cities and communities,” says Alana Officer, senior health adviser at the World Health Organization (WHO).

'Tiny little things'

The demographic shifts underway are unprecedented. By 2020, those ages 60 and older will outnumber children under 5 for the first time in history. By 2050, the WHO estimates that 2 billion people will be 60 or older, up from 841 million today. Older populations in OECD countries are expanding faster in cities than non-cities, with metropolises home to 43.2 percent of those ages 65 and up.

It is this demographic reality that has propelled the age-friendly initiative forward, from Tokyo to Atlanta. The WHO launched a network of “age-friendly” cities in 2010 with about a dozen affiliates, and since then about 320 communities have signed up – Manchester the first in Britain – to rethink their built and social environments and share experiences.

Stefano Recalcati, who managed the “Shaping Aging Cities” project at the engineering firm Arup in Milan, says it is a huge opportunity, and challenge, for architects and city planners alike.

But much of what makes cities “age-friendly” in the WHO network today is so small-scale that alone, the practices might just seem like someone’s good manners. It is the work of the “graffiti grannies," or shopkeepers putting a chair outside their storefronts – or letting older people use the bathrooms.

“These are tiny little things,” says Natalie Turner, senior program manager for Localities at the Center for Aging Better in London. “But it makes a big difference. It is the difference between having people stay out, or having to stay home,” she says.

In Udine, Italy, with over 30 percent of the population over 60, the city has used GIS mapping to identify where its older residents live to make sure there are sufficient pharmacies, clinics, or bus stops, says Stefania Pascut, who leads their efforts. In Dijon, at the forefront of France’s age-friendly initiatives, a new tramway system in 2012 has been a boon to the entire urban community, but it particularly changed lives of older people.

“Before, older people didn’t use the bus,” says Pierre-Olivier Lefebvre, the head of the Francophone network of age-friendly cities, on the sidelines of their recent conference in Paris, which drew hundreds of attendees sharing ideas. “We don’t want it to be that people are active members of society and then after they retire they say, ‘I can’t find my place here,’” he says.

There is a growing sense of urgency among municipalities to begin preparing, says Anne Berit Rafoss, who leads the age-friendly project in Oslo and who recently visited Manchester’s initiatives. “We talk about a wave of older people,” she says. “A wave goes over, this is not something that ends, this is something that is going to keep going.”

Getting their say

Manchester’s wide-ranging “age-friendly” program has stood out for empowering older people themselves to effect change, and its highest body is the Manchester Older People’s Board, which meets every six weeks to look at city policies, from transport to redesign, through the eyes of the elderly.

Bren Fawcett is the deputy of the board. Her office at the neighborhood association NEPHRA in the north of Manchester is so packed with decorations and donated items for their Christmas fundraiser that it is hard to find a space to pull up a chair. The center is bustling. Three in their late 70s and 80s are taking a German class, ahead of a trip to Berlin. As class wraps up, the choir group arrives – intended both for those who love to sing and want to fight cognitive decline. There are iPad classes twice weekly. “They fall in love with them,” says Ms. Fawcett. Tuesday is the most anticipated day of the week: a community luncheon in two sittings.

But her ambitions range beyond this neighborhood organization. In her job on the Older People's Board, Fawcett was crucial in pushing through an Older People’s Charter last year, to broaden their work across the sectors of the city, from businesses to transport to health services. “We are trying to be more radical,” Fawcett says.

The board has no legal powers. But Paul McGarry, the age-friendly strategic leader of Manchester, says they impact policy nonetheless. He remembers in 2005 when the city published a strategic plan including nothing about older people. He says the board called the authors to task.

“They sent their most junior person. He comes along. Our board gave him an absolute roasting, sent him away with a flea in his ear,” Mr. McGarry says. “The next day I get a phone call [from the city, saying], ‘I think we should have something in there about older people.’ That is a routine pattern.”

Judging from conversations with those who frequent NEPHRA, older people want more and deeper change.  When asked if they see their city as, indeed, “age-friendly,” the three learning German answer in unison “no.” One of their biggest complaints is lack of transport connections, which are sparser where they live.

Telly Cassidy, who is nearing 80 and sets off on his bike after class, scoffs at the worldwide accolades Manchester receives. “It is dangerous to walk on the pavement, and cross the road,” he says. He still drives but finds other drivers a menace. “It is frightening. They need to put up more cameras to limit speeds.”

That is something that Fawcett can raise at her Older People’s board meetings. “Transport [policy] isolates people more than anything,” she says.

Hidden benefits

Ms. Turner says that part of adopting an “age-friendly” framework is rights-based. But it is also economically vital.

After the global financial meltdown in 2008, and the austerity that it ushered in, cities have sought ways to cut everywhere. Budgets for age-friendly work have not been spared – but entities like the OECD are trying to focus on the opportunities, not costs, of aging.

Companies are looking at ways to employ older people, utilizing their knowledge as they keep economies productive. Seniors have more money to spend. They also give more time volunteering. In the US in 2014 those over 65 offered 96 hours of volunteer work compared to 32 hours for those ages 25 to 34, according to Volunteering and Civic Life in America.

“If we do not [help them] as they get older to stay engaged in the community and to stay active, what we will have is much more of a dependency focus,” Turner says. “We need to keep them employed, volunteering, care-giving. We need them.”

Many cities are also trying to rethink their health systems, viewing “age-friendliness” as a way to prevent health problems down the road. In the community of Old Moat in southern Manchester, the “age-friendly team” is reaching out to doctors to prescribe “coffee mornings” to older residents to battle loneliness.

“If communities start operating like the good old days, with neighbors going on and looking after dear old Mrs. Smith down the road, then you won’t need so many crisis interventions,” says Don Berry, a retired elementary school teacher who is a community champion – among other hats – for “Age-Friendly Manchester.”

Graffiti grannie Jane Hignett says there is a tendency to blame older people for everything. “They say we are living too long. What do you want me to do? Drop down?”

This crew says no way, unless of course it’s for their latest graffiti venture. John Johnson says of this volunteer work: “Some people carry on where they were, or go below [their previous satisfaction with life]. Others rise above. For me, getting older has brought me back to life.”

Embracing older people

Manchester itself is still relatively young, with about a tenth of the population over 60. In fact, most of the buzz about the Victorian city whose mills stopped humming last century is its reinvention as a city for the young, with a booming university population and bars, restaurants, music venues, and galleries catering to them. 

Susan Cooley, a longtime city councilor, remembers thinking back to around 2000, “hang on.” “Everybody was touting Manchester as this wonderful city to be young in,” she says. “But we were struggling to keep older people resilient and independent and in the city” – and not, she says, in retirement homes or far from the services they have always used.

When it comes to cities, Mr. McGarry says leaders are always trying to sell their dynamism. Berlin calls itself "poor but sexy,” he says. "Where does aging fit into that kind of narrative?”

In Manchester, the city is aiming to put seniors in the heart of it. Take Mr. Berry, who is also what the city calls a "cultural champion," working to bring seniors to arts offerings, and arts to the community. On a recent day, he is preparing for his own night out. Dressed in a black turtle neck and black leather coat, he discusses a radio interview he will do later at a jazz club after a set of The Cookers, a band of veteran musicians. He’s mulling over his questions, to air on a community program he trained for as a cultural champion. 

“I am trying to think of a tactful way to ask these guys, ‘How is it at 70 and 80 you are not just engaging with culture, but you are still performing it?” and then gives up. “I’m going to improvise,” he says. “It is jazz.”

McGarry says that some of their first work – battling perceptions of aging – was among their most crucial. That included a nightclub for the over 50s called “My Generation,” conceived after someone phoned McGarry at city hall. 

“Listen Paul, I don’t want to go see dance [performances],” the resident told him. “I grew up listening to the Rolling Stones and the Beatles. I want a place to dance the night away in the city center.”

Ms. Officer, at the WHO, says ageism creeps into policy in a world that essentially does everything possible to stop aging. “We are restricted by our perceptions around aging. It is at the root of the way that we think, problem solve, the policies we develop,” she says. “We are failing to celebrate the achievement that is older age.”

It’s one reason McGarry, who travels the world, says cities are not doing more to prepare, even though aging populations is something cities can plan for. “I suppose in the age-friendly movement, in its life course, I think maybe we are moving up from a toddler into preschool age.”

But cities are going to have to grow up fast. “We are going to have to, in the next five, 10 years or so, start going big,” he says.

For more in A World Living Longer, the Monitor's look at global aging issues and solutions, please visit our series homepage.