Abstract
Background: The + Agil, a multicomponent program to maintain intrinsic capacity or reverse frailty of community dwelling older adults, has shown effectiveness and is being successfully implemented in three primary care areas (PCA) in Barcelona. As a side project of +AGIL we explored the importance of urban indicators in the neighborhood areas of the PCAs in relation to older people mobility with the final aim of informing urban policies.
Approach: The project was conducted by a team of urban designers, health care professionals and epidemiologists and followed a participatory design with users in four steps: 1. Literature search; 2. Focus groups with users of the +Agil Program (frail or prefrail older adults 65 years old or more) living in the three PCAs, and health care professionals (family physicians, nurses and physical therapists); 3. Surveys and personal interviews, and 4; A world cafe.
From the 57 urban indicators identified in the literature 12 were selected in the focus groups with professionals and users. We created three questionnaires (one for each PCA). First, we asked the users to mark on a map their route from home to the PCA center and then, we asked the users about the importance (1-10 scale) of the indicators for their routes selection. Data and itineraries were digitalized using QGIS software to create heatmaps showing the most frequented routes and the presence of the evaluated indicators. Finaly, 5 users of each Primary Health Care center (15) participated in a world caffe. The team of urban designers showed their conclusions and altogether we discussed them in a structured way through three different activities.
Results: The following variables were evaluated: pedestrian pathways, sidewalk width, street slope, ramps and stairs, benches and seats, trees and green areas, noise, illumination, public transport stops, speed of traffic, bicycles or scooters, parked cars. In general, older people valued negatively characteristics that represented a risk, such as the presence of bicycles and scooters, and positively the presence of benches and trees/green spaces
Some items were considered less relevant, for example, the presence of parked cars or illumination, while others were considered important only in the areas where they were problematic. For example, the presence of ramps and stairs and the slope of the street in one of the areas in which most streets have a high slope.
There were other items that emerged from the discussions: safety was one of the main worries for older people, who expressed concerns about the separation of pedestrian spaces from other uses, such as bicycles and scooters, or the occupation of sidewalks (even wide ones) by terraces. Also for safety reasons, more crowded streets with higher levels of noise and traffic were preferred to quiet narrow pedestrian streets.
Implications: The study poses some contradictions to the modern urban models in which Barcelona is a referent. Ongoing projects of urban pacification should take into account the opinions and preferences of older citizens, in order to adapt the urban environment to their needs, especially related with safety.