Angela Curl

Do changes to the local street environment alter behaviour and quality of life of older adults? The ‘DIY Streets’ intervention

Background The burden of ill-health due to inactivity has recently been highlighted. Better studies on environments that support physical activity are called for, including longitudinal studies of environmental interventions. A programme of residential street improvements in the UK (Sustrans ‘DIY Streets’) allowed a rare opportunity for a prospective, longitudinal study of the effect of such changes on older adults’ activities, health and quality of life. Methods Pre–post, cross-sectional surveys were carried out in locations across England, Wales and Scotland; participants were aged 65+ living in intervention or comparison streets. A questionnaire covered health and quality of life, frequency of outdoor trips, time outdoors in different activities and a 38-item scale on neighbourhood open space. A cohort study explored changes in self-report activity and well-being postintervention. Activity levels were also measured by accelerometer and accompanying diary records. Results The cross-sectional surveys showed outdoor activity predicted by having a clean, nuisance-free local park, attractive, barrier-free routes to it and other natural environments nearby. Being able to park ones car outside the house also predicted time outdoors. The environmental changes had an impact on perceptions of street walkability and safety at night, but not on overall activity levels, health or quality of life. Participants’ moderate-to-vigorous activity levels rarely met UK health recommendations. Conclusions Our study contributes to methodology in a longitudinal, pre–post design and points to factors in the built environment that support active ageing. We include an example of knowledge exchange guidance on age-friendly built environments for policy-makers and planners.

Physical and mental health outcomes following housing improvements: evidence from the GoWell study

Background Existing research points towards physical and mental health gains from housing improvements, but findings are inconsistent and often not statistically significant. The detailed characteristics and variability of housing improvement works are problematic and studies are often small, not experimental, with short follow-up times. Methods A quasi-experimental design was used to assess the impact on physical health and mental health (using SF-12v2 Physical and Mental health component summary scales) of four types of housing improvement works—central heating, ‘Secured By Design’ front doors, fabric works, kitchens and bathrooms—both singly and in pairwise combinations. A longitudinal sample of 1933 residents from 15 deprived communities in Glasgow, UK was constructed from surveys carried out in 2006, 2008 and 2011. Sociodemographic characteristics and changes in employment status were taken into account. Results Fabric works had positive associations with physical health (+2.09, 95% CI 0.13 to 4.04) and mental health (+1.84, 95% CI 0.04 to 3.65) in 1–2 years. Kitchens and bathrooms had a positive association with mental health in 1–2 years (+2.58, 95% CI 0.79 to 4.36). Central heating had a negative association with physical health (−2.21, 95% CI −3.74 to −0.68). New front doors had a positive association with mental health in <1 year (+5.89, 95% CI 0.65 to 11.14) and when provided alongside kitchens and bathrooms (+4.25, 95% CI 1.71 to 6.80). Gaining employment had strong associations with physical health (+7.14, 95% CI 4.72 to 9.55) as well as mental health (+5.50, 95% CI 3.27 to 7.73). Conclusions Fabric works may provide insulation benefits and visual amenity benefits to residents. Front doors may provide important security benefits in deprived communities. Economic regeneration is important alongside property-led regeneration.

Same question, different answer: a comparison of GIS-based journey time accessibility with self-reported measures from the national travel survey in England

Acknowledgements This paper is based on research undertaken as part of the PhD of the first author and was presented in an earlier form at the 50th European Regional Science Association Annual Congress, Jonkoping, 2010. We would like to thank two anonymous reviewers and the special issue editor, Karst Geurs, for helpful feedback which has improved this paper.

Financial Difficulty and Mental Wellbeing in an Age of Austerity: The Experience in Deprived Communities

Critics have called for more attention to be paid to the health impacts of the economic downturn and policy responses to it. Other research has reported that, without any protective measures, deprived communities will be badly hit by austerity. This article uses evidence from fifteen deprived communities to look at the changing incidence of financial difficulties among key at-risk groups, and their associations with mental health, from the pre- to the mid-recession period. High and increasing rates of affordability difficulty were found in respect of the costs of fuel, council tax and clothes, particularly among households with disabled adults, under-occupiers and families with part-time workers. Moreover, increased affordability difficulties were consistently associated with a decline in mental health, at all time periods and for all items of expenditure. The evidence supports a policy counter-narrative focussed on preserving and enhancing mental wellbeing for all rather than the current ‘austerity hegemon’.

Can housing improvements cure or prevent the onset of health conditions over time in deprived areas

BackgroundThere is a need for more evidence linking particular housing improvements to changes in specific health conditions. Research often looks at generic works over short periods.MethodsWe use a longitudinal sample (n = 1933) with a survey interval of 2–5 years. Multivariate logistic regression is used to calculate the odds ratios of developing or recovering from six health conditions according to receipt of four types of housing improvements.ResultsReceipt of fabric works was associated with higher likelihood of recovery from mental health problems and circulatory conditions. Receipt of central heating was also associated with higher likelihood of recovery form circulatory conditions. No evidence was found for the preventative effects of housing improvements.ConclusionsHealth gain from housing improvements appears most likely when targeted at those in greatest health need. The health impacts of area-wide, non-targeted housing improvements are less clear in our study.

Outdoor environmental supportiveness and older people’s quality of life: A personal projects approach

ABSTRACT We present an approach to exploring the role of environmental supportiveness in contributing to older peoples quality of life (QoL), based on Littles ecological model (2010) in which individual and situational factors influence the personal projects of salience to individuals. Personal projects are self-generated and purpose-oriented activities or goals in which an individual is engaged (Little, 1983). The efficacy with which the pursuit of these activities is achieved depends on the nature of the project and the degree to which it is supported by external factors such as the environment. We explore the relationship between the outdoor environment and QoL, drawing on the concept of “environmental support” as presented by Sugiyama and Ward Thompson (2007a). There is a positive relationship between the number of outdoor personal projects older people participated in and measures indicative of their QoL. The relationship between perceived environmental support and QoL measures was significant in projects involving nature but not for other project types.

Housing improvements, fuel payment difficulties and mental health in deprived communities

This paper examines the effect of warmth interventions on self-reported difficulties affording fuel bills and mental health, using a longitudinal sample in Glasgow, UK. Following a period of rising fuel prices and stagnating wages, fuel poverty is high on the political agenda and is a particular issue for those living in deprived communities who may be most affected by rising fuel bills and reductions in employment, wages and incomes in the recent period of recession and austerity. Since 2006, the reporting of difficulties paying for fuel bills has been rising in the study population. Alongside fuel prices and income, energy efficiency is the third key driver of fuel poverty. As such the research seeks to establish whether warmth interventions, designed to improve the energy efficiency of homes can provide protection against worsening financial difficulties and lead to better mental health outcomes for residents. Results suggest that those who report greater frequency of financial difficulty also report worsening mental health. There is limited impact of energy efficiency improvements on perceived fuel affordability difficulties, and where there is an effect, central heating is related to more frequent financial hardships.

Understanding the prevalence and drivers of food bank use: evidence from deprived communities in Glasgow

This article provides quantitative analysis of a self-reported measure of food bank use in the UK, adding to a sparse evidence base. Evidence from fifteen deprived communities in Glasgow is used to examine the scale of food bank use and to consider its relationship with socio-demographic, health, and financial variables. Being affected by welfare reforms was found to increase the likelihood of food bank use. Young men and those with mental health problems were found to be more likely than others to have used a food bank. Food banks appear to be used by groups who are being under-served by the welfare state and suffering the most acute impacts of austerity. The very low prevalence of food bank use among those who struggle to afford food points to their inadequacy as a response to food insecurity.

Geographical Perspectives on Transport and Ageing

Due to increased life expectancy and better physical health, older people are on average more mobile compared with earlier generations. Although being in better health and physically fitter than previous generations, older adults are likely to be face difficulty when needing to travel. This can present challenges for the provision of transport services in view of changes in ability to use certain forms of transport, changes in lifestyle and income associated with later life. Despite this, policy and discourse in most western countries maintain extending independence and ageing in place as vital requirements to a dignified healthy later life. Transport must play a key role in this and proper investment in other modes and the public realm can improve mobility for older people.

Walking with Older Adults as a Geographical Method

This chapter discusses the process of undertaking and analysing walking interviews with older adults. We discuss participant recruitment, including issues such as representing the experiences of less mobile adults. We then reflect on what can be gained from the process of going on a walk as opposed to static interviews. The chapter will also discuss issues of data collection, through audio recording, photographs and using GPS technology to record the route of the walks. Such approaches uniquely allow interview data to be geographically contextualised, which is crucial when exploring the role of particular built environments on individuals’ perceptions and experiences of that environment. We demonstrate the value of walk-along interviews when aiming to understand the role of the built environment for older adults’ mobilities.