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Health & Place 14 (2008) 299–312

www.elsevier.com/locate/healthplace

Local environments and older people’s health: Dimensions froma comparative qualitative study in Scotland

Rosemary Day�

School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK

Received 15 March 2007; received in revised form 6 July 2007; accepted 17 July 2007

Abstract

Based on the perspectives of older people themselves in three urban neighbourhoods in the Glasgow region of Scotland, this

article explores the ways in which the local outdoor physical environment may support or challenge older people’s health. Five

dimensions are proposed: cleanliness; peacefulness; exercise facilitation; social interaction facilitation; and emotional boost.

Consideration is also given to potential equality issues, arguing that such aspects of the local environment may

disproportionately affect older people, and also that relevant environmental qualities vary between places. Greater equity and

the improved well-being of older people may be achieved through planning and design consideration across sectors.

r 2007 Elsevier Ltd. All rights reserved.

Keywords: Older people; Environmental equity; Environment; Neighborhood; Planning; Health

Introduction

The population of the developed world is ageing.In 2005, 17.4% of the population of Western Europeand 12.4% of North America were aged 65 andolder; by 2020 these figures are projected to be21.3% and 16.1% (United Nations, 2005). Whilst aminority of the older population reside in hospitalsand care homes, the great majority continue to livein the wider community until their very final years;indeed, this is the option generally preferred by boththe individual and the state. It is therefore impera-tive that our communities are planned and designedin a way that facilitates the health and well-being ofthis significant sector of the population.

e front matter r 2007 Elsevier Ltd. All rights reserved

althplace.2007.07.001

21 414 8096; fax: +44 121 414 5528.

ess: r.j.day@bham.ac.uk

That said, it is also essential to recognise thatolder people are not a homogeneous group (Golant,1984, Daatland and Biggs, 2006). Physical ageing isa process that starts in our earliest years andhappens at different rates and with different out-comes, depending on a myriad of circumstances andchoices over the life course. Nevertheless, as agroup, older people (defined by the World HealthOrganisation as aged 60 and over) are more likelyto experience a range of health-related changesand challenges, with the likelihood of these increas-ing with increasing age: immunity to infectiousdisease is lowered (Pawelec, 2006); the incidence ofmany chronic illnesses including cardiovasculardisease, cancer, and diabetes increases (WHO,1998, 2003); senses become impaired (WHO,2003); muscle strength and the range of motion injoints decline with age (WHO, 1998, Schultz, 1992);

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and disturbances in gait are more common (Immsand Edholm, 1981), making older people moreprone to falls (Lord et al., 2001). Additionally,circumstances such as restrictions in activity and theloss of friends and partners can pose challenges tomental health: depression, although not an essentialfeature of ageing, appears to be a not uncommonexperience (Beekman et al., 1999; Help the Aged,2007).

Given the range of physical changes that tend toaccompany ageing, it is to be expected that olderpeople might, as a cohort, be especially sensitive totheir physical surroundings (Robert and Li, 2001;Glass and Balfour, 2003). Further, it is likely thatthe context of the residential neighbourhood willhave a greater impact on older people relative toother age cohorts, as people tend to spend a greaterproportion of their lives closer to home as they age(Rowles, 1978; Golant, 1984; Kellaher et al., 2004;Phillips et al., 2005). For these reasons, the need topay attention to older people’s environments maybe understood as an environmental equity issue:there is a need to ensure that the neighbourhoodenvironment does not impact most negatively on itsolder residents. Such an inequity, occurring withinany given locality, may be additional to any inequitythat occurs between places. This article is concernedin part with both these dimensions.

Older people, neighbourhoods, and well-being

Conceptual models in environmental gerontologyand associated work recognise that the ability forolder people to function in their living environmentsis an outcome of the dynamic between thecompetencies of the individual and the demands ofthe specific environment (Lawton, 1980, 1982; Carp,1987; Glass and Balfour, 2003; see also Verbruggeand Jette, 1994 on the disablement process). AsGlass and Balfour (2003) usefully note, the envir-onment may challenge competence but may also‘buoy’ it. These insights have been most oftenapplied with a focus on designing suitable housingenvironments for older people (see e.g., Scheidt andWindley, 1998; Peace and Holland, 2001), payingless attention to the wider residential environment.Such work has also concentrated rather narrowlyon physical function, paying less attention toother ways in which physical surroundings, whichmay include built and natural elements, may stressor support the older individual. Although the workof Rowles (1978) and Golant (1984) laid the

foundations for exploring more experiential andexistential aspects of older people’s environmentalexperience, including that in urban neighbourhoods,more recent geographical work on ageing, health,and the meaning and construction of place has alsotended to focus on home and care-giving environ-ments (Kearns and Andrews, 2005). Understandingof the wider residential environment and itscontribution to older people’s health and well-beingremains an underdeveloped area to date.

Surveys of older people’s general satisfaction withtheir residential neighbourhood have tended toconclude that physical features and/or appearance,and social dynamics, are important influences(Baressi et al., 1983; Scharf et al., 2002). Friendsand neighbours have been found to be among themost valued assets, with good social bonds increas-ing residential and neighbourhood satisfaction,whilst problems crossing roads and walking onpavements, or a poor general overall appearancecan be strongly felt negatives (Fokkema et al., 1996;Scharf et al., 2002). Recent qualitative work, mostnoticeably from North America, has also sought toidentify features of the wider community settingaffecting the quality of older peoples’ lives. Feldmanand Oberlink (2003) for example, based on a pan-US focus group study, propose a model of commu-nity ‘elder friendliness’, naming financial security,health and health care, social connections, housingand supportive services, transportation, and safetyas key categories, although arguably some of theserepresent attributes of individuals or households.

Others have consistently found poor pavementsand problematic traffic signals to be detractors(Richard et al., 2005; Hanson and Emlet, 2006)whilst accessible services, adequate public transportand neighbourhood safety and cleanliness have beenpinpointed as community contributors to quality oflife (Richard et al., 2005).

While such quality of life studies take a broadscope, other work has focussed more explicitly onhealth and health-related outcomes, though thebody of work concerned with older people is asurprisingly small subset of that concerned withneighbourhood and health more generally.Although studies using individual socio-economicstatus measures have tended to find diminisheddifferentials in health by s.e.s. at older ages (seeRobert and House, 1994), Robert and Li (2001) byusing multi-level models were able to demonstrate apositive association at area level between commu-nity socio-economic status and the self-assessed

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health of older adults in two national US surveys.There has been some speculation that the effectmight be more marked at the lower end of thesocio-economic scale where exposure to variousstressors would be concentrated (Robert, 1998).Krause (1996) demonstrated such a non-linearquantitative relationship, between older people’sself-rated health and interviewer-rated neighbour-hood deterioration, again in a pan-US sample,finding that this effect was partly mediated by strainon friendships associated with living in a dilapidatedenvironment.

A few studies have addressed mental health andpsychological well-being in relation to older peo-ple’s area of residence. Elder mental health has beenquantitatively positively associated with residentialsatisfaction and with community satisfaction inspecific US communities (Windley and Scheidt,1982; Schwirian and Schwirian, 1993); Robertset al. (1997), using the Alameda County (California)survey, linked higher overall rating of neighbour-hood problems, such as poor lighting and heavytraffic, to risk of a major depressive episode acrossthe population, including but not exclusive to olderpeople. A longitudinal study in Norway (Dalgardand Tambs, 1997), employing two surveys 10 yearsapart, found that improvements in neighbourhoodquality were accompanied by improvements inpopulation mental health, with the effects beingmost marked in the elderly. The authors attributedthe improvement to reduction in environmentalstress and to social factors associated with improvedservices and facilities but could offer no clearreasons for the greater effect among older cohorts.

Connecting with the gerontological models offunctionality cited earlier, there has also been someinterest in neighbourhoods and older people’sfunctional health and/or mobility. Using data fromthe Alameda County survey again, Balfour andKaplan (2002) found that multiple problem neigh-bourhoods were associated with decreased physicalfunction over 1 year, with the strongest singlepredictors being noise, poor lighting, heavy traffic,and poor public transport. Such features seem likelyto diminish the amount of exercise taken. Otherquantitative and qualitative studies internationallyhave linked higher levels of walking with theavailability and proximity of services such as shopsand leisure facilities—provided the services are ofsufficient quality (Patterson and Chapman, 2004;Fobker and Grotz, 2006; Michael et al., 2006) andwith the availability of attractive, pedestrian-

friendly walking routes (Booth et al., 2000; Michaelet al., 2006). There are important issues here forurban design that have recently begun to drawattention. Surface materials, seat availability anddesign, steps and access routes, lighting, streetlayout, and signage have all been noted aspotentially posing problems for older people (Val-demarsson et al., 2005; Burton and Mitchell, 2006).Burton and Mitchell make design recommendationsfor accommodating the needs of older people withdementia in such features: these include irregulargrid pattern street layout; smooth surfaces withoutpatterning; minimal signs with simple informationusing clear colour contrast; small, informal openspaces; and varied but recognisable architecturalforms, as well as many others.

There have, then, been a number of possibilitiesraised regarding the potential for the physicalresidential locale to affect the collective well-beingof older people. Both static physical featuresand physical environmental problems mightaffect health and well-being, directly or indirectly.Links between physical and social spheres havebeen suggested. The variety of approaches, howevermake the overall picture rather fragmented,and a preponderance of techniques makingquantitative associations means the underlyingmechanisms are often not clear. Issues of spatialinequality have hardly been explored, although avery few studies have taken a particular interest inmore disadvantaged areas (Krause, 1996; Scharfet al., 2002, 2004); generally it is implicit that therelevant place characteristics are subject to spatialvariation.

What is also notably lacking is the voice of olderpeople themselves. Despite a recognition that theneeds of older people are often neglected inplanning, environmental design, and regeneration(Golant, 1984; Teo, 1997; Riseborough and Sribjla-nin, 2000, Glass and Balfour, 2003; Burton andMitchell, 2006), the studies that have engaged indepth with the experiences and views of older peoplethemselves in issues related to these spheres are stillfew. This is a significant omission and one that actsto perpetuate a view of older people as passive,incapable and withdrawn. Research and consulta-tion techniques that give older people agency andvisibility are much needed, if enabling environmentsthat do the same are to be achieved.

The work presented here aims in part tocontribute to redressing this, as well as contributingto conceptual understanding of environmental

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health inequalities. Based on qualitative work inthree case study localities in Scotland, the followingsections explore older people’s understandings ofhow the local physical environment can impact onthe health of the neighbourhood’s more elderlyresidents. An additional interest is taken in potentialdimensions of inequality, in terms of how theseimpacts might differentially affect older people; andin terms of how such age-differentiated effects mightvary between places.

Case study areas

Data for this study were gathered in threedifferent case study areas in the Glasgow andStrathclyde region of Scotland, between July 2005and June 2006. The three areas were selected inorder to provide examples of different types of localurban environment, covering an inner urban area, asuburban neighbourhood, and a Small CoastalTown with a rural hinterland. They also reflect arange in terms of levels of community socio-economic status. For all three areas, the proportionof the population at, or over, retirement age(currently 60 for women, 65 for men) is above theScotland-wide estimate for 2005 of 19.14% (GeneralRegister Office for Scotland, 2006).

The boundaries of each area for the purposes ofthis study were drawn to give an on-the-groundcoherence, encompassing what might be seen as aspecific locality, largely reflecting the configurationof streets in relation to services such as central shopsand transport links but also having a nameand identity recognisable to residents and thosenearby. In the case of the inner city and suburbanareas, each at the time of research coveredthe majority of one administrative ward.1 The smalltown corresponds to a census ‘settlement’.2 Briefdescriptions of each case study area are givenbelow. For ethical reasons, to protect the anonymityof participants given that the areas are relativelysmall, and to avoid any detriment or potentialstigma to the places involved, the localitieswill be referred to in this article by descriptivepseudonyms.

1A ward being an administrative sub-division of a local

authority area. At the time of research, Glasgow wards had

populations in the region of 6000–9000 and one elected local

councillor per ward.2A census geography unit which in Scotland’s 2001 census

comprises a collection of contiguous high density postcodes

bounded by low density postcodes or water.

Area 1: Inner City Neighbourhood

This case study area lies at the heart of the city ofGlasgow, and has traditionally been a working classneighbourhood with much of the populationhistorically engaged in locally sited manufacturingindustries. The neighbourhood has a history ofpoverty and the decline in the industrial economicbase in recent decades has resulted in furtherentrenched deprivation: the ward falls within the20% most deprived areas in Scotland, measured bythe Scottish Index of Multiple Deprivation (ScottishExecutive, 2006), with parts in the most deprived5%. The majority of housing is in traditionaltenement flats built around 1900, arranged in 4storeys around communal stairwells, and with smallshared outdoor enclosed areas at the rear. There isone park, of roughly a quarter mile by a quartermile, within the neighbourhood. The neighbour-hood has a high street, which experiences heavytraffic, and is adjacent to an urban motorway. In2004, 22.1% of the ward population were ofpensionable age (Glasgow City Council, 2005).

Area 2: Suburban Estate

This estate is situated at the edge of the city ofGlasgow and was built in the 1950s, largely housingworkers for the newly developing peripheral indus-trial estates. Much of the housing comprises low-riseterraces and flats, with front and back gardens.Some of the flats, where several study participantslived, are in higher rise blocks of 10 storeys or more.In the centre of the estate are a few shops and agreen with a play area. Within the estate are furtherblocks of open space, mainly grassed over andunlandscaped. Roads are quiet, with little throughtraffic. In 2004, 23.1% of the population were ofpensionable age (Glasgow City Council, 2005); allthe study area falls within the most deprived 40% ofScottish datazones,3 with parts in the most deprived10% (Scottish Executive, 2006).

Area 3: Small Coastal Town

This town, population c. 11,000, is situated on thewest coast of Scotland, within the Glasgow city

3A spatial unit for collection of data used to produce Scottish

Neighbourhood Statistics including the Scottish Index of Multi-

ple Deprivation. Datazones have populations between 500 and

1000.

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region. Whilst overall performing quite well insocio-economic terms, the town as a whole encom-passes variation: datazones within the town rangefrom the least deprived third to the most deprivedthird in Scotland. Housing ranges in age and in sizefrom medium-rise flats to larger detached bunga-lows and houses. The town centre has a variety ofshops and services arranged around several streets.Traffic can become congested in the more centralnarrow streets and tends to move slowly. There is along pedestrianised seafront stretching the length ofthe town and beyond, along which flowerbeds andbenches are plentiful. To the rear of the town liesopen countryside and moorland. This area ofcoastline is popular with people relocating afterretirement; the 2001 census gives a figure of 27% ofthe population of the settlement area being 65 orover (General Register Office for Scotland, 2003).4

Methods

In each of the three case study areas, datacollection made use of interviews and field observa-tion. After visiting each area, local communitygroups whose members included senior citizens, forexample lunch clubs, senior citizens’ social clubs,and voluntary organisations, were contacted.Through these contacts, individuals were recruitedfor one-to-one interviews; interviewees were thenasked to recommend acquaintances as furtherparticipants. Care was taken that participants werenot all members of one social network. Individualinterviews generally took place at the participant’shome although some were conducted at communitycentres. On two occasions the interview involved amarried couple. In the case of the Inner City andSuburban Estate areas, fewer individuals volun-teered for interviews and so senior citizens’ socialgroups were visited. Group interviews then tookplace at some of these, with between 3 and 8individuals at once. In all three areas however, themajority of data was ultimately provided byindividual interviews.

A total of 45 older people participated in inter-views across the three areas. Ages of participantsranged from 62 to over 90, with the majority beingover 70. All were retired. Two participants lived insheltered accommodation; the rest lived fullyindependently. All but one were able to walk outof doors to some extent though several had limited

4Figures on pensionable age are not available for settlements.

walking ability. One participant was recently house-bound due to illness.

Interviews were semi-structured, and designed toinclude discussion on likes and dislikes about thearea, outdoor activities and habits, thoughts aboutwhether the area was a healthy place to live, andimprovements they would like to see. Prompts andfollow-up questions were used where appropriate.Interviews were recorded, transcribed verbatim, andanalysed thematically with the aid of Atlas Tisoftware. An initial coding frame employed codesthat related closely to the interview questions;iterative reading and recoding of the data led tothese codes being refined and added to. In this way,the thematic framework presented in the resultssection is substantively grounded in the data whilstbeing broadly orientated by the project’s initialresearch questions. Interviews with individuals,couples and groups were analysed using the sameframework. It was noticeable that in couple inter-views, the man’s perspective dominated and that ingroups, there was less discussion of personal healthissues and practices, and more discussion ofpotential improvements to the area. However,because participants within couple and group inter-views were very well acquainted with one anotherthere was sufficient disclosure of personal feelingsand practices for employment of the same frame-work to be sustainable.

At each study site, the author also undertook fieldobservation in public places, on different days of theweek and at varying times of the day. During thesesessions, different parts of the study areas werevisited, concentrating on the outdoors but at timesincluding public indoor spaces such as cafes. Theactivities and behaviour of older people wererecorded in fieldnotes, rather than for exampleagainst a grid or checklist. Attention was also paidto when and where older people were absent. Inaddition, the behaviour of others was noted where itintersected with the activities of older people.Interaction was not purposefully initiated as partof the observation but took place to the extent thatoccurred naturalistically in situ. At times, pointsand queries arising from observations were dis-cussed with later interviewees. Fieldnotes were alsoanalysed in conjunction with the interviews, byascribing sections of notes to themes. They providedadditional material pertaining to the identifiedthemes, and at times suggested new themes. Inter-view transcripts were re-examined with respect tosuch new themes.

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The following sections identify and explain thedimensions of the local outdoor environmentidentified across the three areas as being importantfor older peoples’ health. Evaluations of each studyarea with respect to these dimensions are alsodiscussed. As the focus of this article is on olderpeople’s own views and understanding, the analysisrelies mainly on the data collected in the interviews,but additional material from the observation isreferred to where it provides additional detail orillustration.

Results: dimensions of a healthy outdoor environment

for older people

A healthy outdoor environment is clean and free from

pollution

a healthy place y. I suppose clean, fresh air[Woman, 80s, Coastal Town]

The importance of air quality was one of the firstpoints raised by many research participants, intalking about connections between environmentalconditions and health. This was common to allstudy areas. Fresh air was believed to be good forpeople in general, with sea air viewed as particularlypleasant and beneficial to health. Assessments of thelocal air quality however differed between the threeplaces. In the Coastal Town, all intervieweesbelieved the air to be clean, and indeed this wasfelt to be a particular advantage of the location.Reasons for this cleanliness were given as theseaside location, and the lack of any nearbyindustry. In the Inner City Neighbourhood, bycontrast, the air was described by most as quite bad;the pollution there was attributed mainly to traffic.The Suburban Estate was felt by residents to haveacceptable air quality, as traffic levels were low andthe location was away from the inner city, whichwas seen as more polluted. That these assessmentsreflected more dimensions than the purely physicalis a plausible interpretation (see Day, 2007); never-theless they show a crucial sensitivity to air qualityand an awareness of likely sources of pollution.

Regarding the health impacts of air quality, someinterviewees expanded on the specific benefits ofclean air, for example:

you come home having been in the fresh air,you’re ready for a meal, you sleep better y yourlife is so much easier because of that.[Woman, 80s, Coastal Town]

Another participant in the Small Coastal Townfelt that the clean air made the town especiallysuitable for older people. The negative impact of airpollutants, particularly particulate pollution, issomething that older people might be expectedto feel particularly susceptible to, especially ifthey suffer from respiratory complaints or heartproblems (Department for Environment, Foodand Rural Affairs (DEFRA), 2002; Seaton et al.,1995). Although this was not overwhelminglyexpressed among these interviewees, one InnerCity Neighbourhood resident explained that shebelieved the number of her (older) acquaintanceswith chest complaints was attributable to the trafficpollution:

I know so many people like myself that havetaken chest infections, and asthma, and otherrelated lung problems and I think it’s because ofthe pollution that is coming over the [urbanmotorway] and it was supposed to help us in [y]Road reduce the traffic but that has nothappened.[Woman, 80s, Inner City Neighbourhood]

A second major source of uncleanliness that wasbrought up, and which was identified as a healthhazard, was rubbish. All agreed that rubbish andlitter were undesirable and spread disease andvermin. Out of the three localities, it was seen as abig problem only in the Inner City Neighbourhood,where participants complained that roadside binswere often overflowing and that some residents andbusinesses left bags of rubbish on the streets at thewrong time or in the wrong place for collection.These then attracted rats. In the Suburban Estate,several participants complained about the litteroutside food take-away shops on the nearest mainroad; the concern was also about it being unsightly.In the Coastal Town, it was noted that a lot ofrubbish accumulated along the seafront duringweekends and holidays, but the efficiency of thecleansing services in clearing it quickly was in thiscase praised.

Dog faeces were another source of annoyancefor many. Clearly these could constitute a healthhazard, although in this respect the risk was seen aspertaining more to children. This issue was greatestin the Suburban Estate, where the open grass areasclose to the housing were favoured places for thewider population to exercise dogs.

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A healthy environment is peaceful and quiet

I like peace and quiet. I like, I mean you can hearyourselfy you can get to sleep at night, nothingdisturbs you.[Man, 70s, Coastal Town]

Noise was a somewhat different pollutant dis-cussed at some length during many interviews. Tosome extent, noise issues were connected withneighbours’ indoor activities such as vacuuming orDIY work. Outdoor environmental noise, howeverincluded traffic noise, noise from businesses, andnoise from people congregating or passing by. Suchnoises could be annoyingly loud, aggressive, orbothersome at night.

Participants across all three areas talked aboutliking ‘peace and quiet’. The Coastal Town againwas felt to be blessed in this respect and the easewith which one could find peace and quiet there wasa much-cited advantage. For several of those whohad relocated there, this had been a motivatingfactor. Individuals in both the Suburban Estate andthe Inner City Neighbourhood were sometimesbothered by outdoor noise, particularly when itwas nocturnal or aggressive sounding. A certainlevel of environmental noise was however tolerated,and some individuals, especially those living alone,stressed that it was possible to be too quiet, andthat they liked to be aware of some life around themsuch as people passing by and children playing(see also Rowles, 1978).

High noise levels though were felt to be stressful,even frightening, and to disrupt sleep if occurring atnight. There was some disagreement about theextent to which noise was a particular issue for olderpeople. Some participants thought quiet to be auniversal requirement across age groups, but severaldid feel that it became more important with age:

Participant: I think [quiet] is very important.Interviewer: Is it more important as you get olderor do you think everybody likes quiet?Participant: No I think you want a quieter life.You want things around about you to be kind ofserene and quiet, although you do like to meetsomeone and talk.[Woman, 80s, Inner City Neighbourhood]

Although some felt this was simply a matter ofchanging lifestyle preferences with age, otherparticipants explained that they felt more sensitiveto noise as they got older, implying this was due tophysiological change. A further important point,

made by one person in the Suburban Estate, wasthat sudden, surprising noises were more disturbingto older people as they felt more generally vulner-able and therefore prone to anxious reactions.

A healthy outdoor environment facilitates physical

exercise

I try to walk as much as possible because I ambad with arthritis. I find if you sit too long, oryou don’t do exerciseyit really makes it worse.[Woman, 70s, Inner City Neighbourhood]

Participants in this research knew that physicalexercise was beneficial to them in many ways,including combating cardiovascular problems andmaintaining mobility. Almost all intervieweeswalked to some extent, often making a particulareffort to do so for health reasons, as the abovequote illustrates. Discussions revealed that severalaspects of the local environment might affect thedegree to which older residents felt able andmotivated to walk around out of doors.

One set of issues related to the presence orabsence in the built environment of physicalobstacles to mobility, as highlighted by someprevious work (Valdemarsson et al., 2005; Richardet al., 2005; Hanson and Emlet, 2006). The physicalcondition of pavements emerged as extremelyimportant. Uneven surfaces might occur as a resultof repeated digging and infilling by utility compa-nies, poorly laid and maintained paving, weath-ering, or the presence of drainage sinks. Suchunevenness could trip people up or upset balance,and additionally, potholes and gratings could catchwalking sticks. Likewise, participants identifiedhigh kerbs as presenting difficulty and dangerto older people. For anyone experiencing dimin-ished strength, balance, joint flexibility or impairedeyesight, negotiating these high kerbs could behazardous:

And the high kerbs, so if we are going to a certainplace we have got to say ‘now we have got to goalong there and there’s a low kerb there, and godown here, but I have got to cross there andmove along there’. You can’t just go from A to B.[Man, 90s, Coastal Town]

Further obstacles to walking that were identifiedby several participants included advertising boards,shop display rails and rubbish bins that were all attimes put out on pavements. Swerving to accom-modate these could upset the balance and gait

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stability of the less sprightly, and where pavementswere narrow it could necessitate stepping into theroad.

Secondly, as well as the built environmentproviding potential obstacles to mobility, so toowas the natural topography significant. Olderpeople in general preferred flat places to walk, suchas the Coastal Town’s seafront. Those with mobilitydifficulties and heart conditions for examplestruggled to walk up slopes. Whilst such topogra-phical features are difficult to change, it may beimportant to take account of them in some planningsituations, for example when siting residentialhomes or other facilities to be used largely by olderpeople.

Third, in order to be able to cover some distanceby walking, it emerged that many older persons alsoneeded quite frequent places to sit and rest (see alsoValdemarsson et al., 2005; Burton and Mitchell,2006). As a participant in the Suburban Estateexplained about some recently installed benchesthere:

if [older people] are out round to the shops, orthe community centre here, they could alwayswalk back and sit in there in the summer for halfan hour if you like and have a rest. You havealways got to remember that the older ones likeus, you can get tired.[Man, 70s, group interview, Suburban Estate]

Observation confirmed this: to give an example,one episode was recorded where an older woman,slow and unsteady in gait, did indeed rest on thesesame benches for a few minutes on each leg of ajourney from her house to the post office and back.Without the chance to rest it seemed quite possiblethat the journey, totalling about 500m, would havebeen too much for her.

Fourth, traffic routing and management had arole to play in making streets and neighbourhoodsmore or less walkable for older people. People weremore inclined to walk where density was low andthe traffic moved more slowly—this would reduceexposure to pollution, make streets quieter anddecrease feelings of physical vulnerability.

Fifth, an important motivator for people walkingoutside was the pleasantness of the overall environ-ment, particularly of potential walking routes andsitting places (see also Michael et al., 2006). Theseencouraged people to take walks for pleasure:several participants had favourite walking routesin and around their neighbourhood. In the Coastal

Town, the natural landscape was a great motivatorfor people to walk and sit outside, especially on thesea front, where watching boats and shipping wasalso a popular pastime. Around the SuburbanEstate, favourite routes might incorporate ‘moreinteresting’ streets with gardens and architecturallyvaried houses.

Lastly of the several aspects affecting walkabilitywas the availability and positioning of key services.As noted in earlier literature (Patterson and Chap-man, 2004; Fobker and Grotz, 2006; Michael et al.,2006), one motivation for people to walk, orsometimes cycle, was undertaking errands such asvisiting shops or the post office. Other ‘support’services that were very important for older peopleincluded cafes, public toilets, and transport. Toiletsallowed participants to feel more confident aboutbeing out of the house for extended periods of time;all three study areas were felt to have too few publictoilets. Cafes allowed people to stop for a rest whileout, if they felt able to spend money in this way.Public transport also supported people to do somewalking in preferred places that might be somedistance away, without being obliged to make a longround trip completely on foot:

Yesterday we walked down [to the seafront] fromhere and took a rest and then finished up goingalmost to [y]. Coming back, catching the busand coming home.[Couple, 80s, Coastal Town]

Assessing the three case study localities, itappeared that the Small Coastal Town raised themost complaints about environmental obstacles,including uneven surfaces, difficult kerbs, andcluttered streets, which were also often narrow. Asone woman in her 80s put it, ‘‘everybody you see atsome time has a plaster or bandage on cos they’vetripped over the pavement’’. In most other respectshowever, it was quite advantaged, having the flatscenic seafront, with many benches and well-maintained flower beds, relatively low traffic densityin most streets, and many shops and cafes locatedclose together in the town centre, with buses alsoavailable. These qualities enabled and encouragedmost participants to take quite frequent walks, evenif they were limited in their extent.

In the Suburban Estate, participants identifiedsome areas of uneven pavement; a certain amountof bench provision was made use of, as noted, butsome felt there were too few in other places. Trafficdensity was lowest here, but still, relatively few

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participants walked for pleasure around the area—most walking was associated with errands, such asgoing to the shops, and people were more inclinedto go further afield if they especially wanted to gofor a walk, such as to larger city parks, possibly bybus. The main environmental reason for thisappeared to be the poor maintenance and land-scaping of the local area. Although there were open,green spaces, observation confirmed they were oftenuneven, overgrown and littered with broken glass.They were also dull to look at: residents’ lack ofengagement with these spaces in part echoes Ulrichand Addoms (1981) study finding that urbanresidents did not especially like empty grass-coveredspaces lacking vegetation and trees. One SuburbanEstate interviewee described how he used to take astroll around the local bowling green, but that thiswas no longer possible as it had been built on byrecent housing development. Local services werealso few, and interviewees often said they didn’t goaround the estate much, because they had ‘noreason to’.

Residents of the Inner City Neighbourhood didwalk, but again mostly through the need to getsomewhere, or else through a determination to keepmobile—few actively enjoyed the environment.Traffic density was worst here, and the nearbyurban motorway also increased pollution andformed a physical barrier to reaching some destina-tions. The shopping area and other communityfacilities did supply places to walk to, and bencheswere provided and well used in this vicinity. Benchesin the park were largely vandalised and wereavoided, and in fact most interviewees avoided thepark altogether out of fear for their safety. Positivepoints for walkability were the local bus availabilityand in particular the pavements, which had recentlybeen overhauled and which residents were happywith.

A healthy outdoor environment supports social

interaction

So you walk down the street y ‘good morning,lovely day, how are you keeping, you’ve got astick, what happened?’y that kind of thing. Andpeople talk to you.[Woman, 80s, Coastal Town]

Interviewees often expressed a clear link betweenlevels of older people’s social involvement, and theirhealth. Those who got out and about, and took partin social activities, it was felt, were less likely to be

‘‘sitting in the doctor’s surgery saying how ill theyare’’ [Woman, 60s, Coastal Town], and less likely tosuffer emotional and cognitive decline. In discussingthe local environment and how interviewees used it,it became clear that spending time out of doors wasvery often associated with some form of socialisingand that this was extremely important to the greatmajority of participants. Having company for walksfor example could be the deciding factor in whetheror not they were taken and equally excursions, evensmall local ones, could provide a focus for spendingtime with a friend or for a social gathering. Thepotential for impromptu social interaction whenoutside was also very highly valued, and as bothinterviews and observation revealed, was somethingthat the physical environment might influence. Thehealth benefits of an environment that facilitatedsocial contact would be likely to include improvedmental health (as suggested by Dalgard and Tambs,1997) and all the benefits associated with increasedmotivation to, and therefore incidence of, exercise.

The features that appeared to promote socialinteraction were largely those that promoted walk-ing—not surprising, as the more people were outwalking, the greater the likelihood of meetingfriends and acquaintances. The walkability of theCoastal Town therefore, combined with the locationof services such as shops and cafes, allowed peopleto meet and socialise whilst doing their necessaryerrands. Even people who were not well acquaintedmight see each other regularly, and so the commu-nity felt connected and supportive:

Husband: We used to go out on messages [i.e.shopping], it took us more time stopping andtalking to people than actually doing the shop-ping because when you meet so many peopleyIwas out this morning and I met 4 people. Andthey were asking how is [wife’s name] getting on?Wife: You feel it’s a very caring community.[Couple, 80s/90s, Coastal Town]

The environment cannot be seen as responsiblefor creating the ‘caring community’—this waslargely due to good social networks, strong churchcommunities, and an active voluntary sector. How-ever, the environment did facilitate regular contactand allowed people to grow and maintain relation-ships, and also to notice if someone was in poorhealth.

By contrast, in the Inner City Neighbourhood—which also has several functioning churches and anactive voluntary sector—people did not enjoy

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walking on polluted busy roads, and complainedthat the local services had declined or relocated. Theeffect that this had had on the social fabric wasmarked:

Participant: [in the past] each area had all theseshops, you could buy here and there, and crossthe road and get so many things on the otherside. It was lovely, it was an outing.Interviewer: So everybody did their shoppingand-?Participant: Yes. Everybody used the local shopsandy you met people practically every otherday. You could meet and stand and blether [i.e.chat] to people for as long as you liked. But that’swhat I am saying, the companionship—that’sgone now I think.[Woman, 90s, Inner City Neighbourhood]

The Suburban Estate experience in this regardwas quite similar to the Inner City Neighbourhood.Because fewer people took walks locally andbecause there were fewer local services to visit,opportunities for street socialising were diminished.

Benches have already been noted as providingcrucial support for older people out walking;observation revealed that they were also importantinformal sites for socialising. Older people were notjust resting on benches, they often sat and talked.Teo (1997) noted how older people opted tocolonise such informal spaces for social interaction.This current study found the location need not bescenic: for example, in the Coastal Town, roadsidebenches were seen used in this way as well as thoseon the seafront.

A further issue to arise in interviews regarding thedesign of the built environment and its effect onsocial interaction was the layout of houses andstreets. Streets with open aspects and few walls andhedges made it easier for neighbours to commu-nicate and to sight each other regularly. In this way,they might also be more aware if for examplesomeone had not left their house for a couple ofdays. Conversely, those participants who lived inlarger blocks of flats, especially the higher rises inthe Suburban Estate, felt that there was littleopportunity to become familiar with neighbours,because shared space was lacking:

Participant: I have been here three years and Iwas going to a meeting one night and there was alady standing in the foyer, and it was lashing [i.e.raining hard] and I said you will be glad to go

home. She said I live upstairs. I went well whendid you move in? Ten years ago.Interviewer: And that’s the first time you hadseen her?Participant: The first time I had seen her. Somepeople in this block I haven’t seen.[Woman, 60s, Suburban Estate]

A healthy outdoor environment is emotionally

uplifting

I would imagine everybody wants to look at athing of beauty. It kind of lifts your spirit toseey[Woman, 80s, Inner City Neighbourhood]

A significant way in which the outdoor environ-ment was felt to contribute to the quality of olderpeople’s lives was through its ability to provide whatmight be termed an ‘uplifting experience’. This wasa quality of life issue, but for many had clearimpacts on mental health in particular. Someinterviewees described how the aesthetics of theenvironment could combat depression and ‘low’feeling. In the Coastal Town, many felt that theview across the sea and the islands had a particularpower to do this, for example:

I think it makes all the difference, I mean I can sithere, feeling not too well, or, maybe just insidemyself, and I can sit and look out thereywher-eas if I was in a flat in a city, and looking out atsomebody else’s house, or the traffic, I think I’dbe depressed.[Woman, 80s, Coastal Town]

Another interviewee explained how sitting andlooking at the view out to sea gave him somecomfort and helped him cope with his feelings afterbereavement. Whilst depression and bereavementare clearly not confined to older people, they are notuncommon experiences in older age. Isolation canbe felt acutely (see Findlay, 2003), and loss of aspouse especially hard to cope with. Depression andnegative emotions can also result from bereavementand from coping with poor physical health (Helpthe Aged, 2007; Korpela and Ylen, 2007).

The elements of a good view were not only relatedto the sea. Several Suburban Estate residents forexample had good views of the mountains north ofthe city on clear days and they prized these viewsvery much. In general, such vistas of natural sceneryseemed to divert people’s attention from theirimmediate pre-occupations (see also Kaplan and

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Kaplan, 1989) and to impart a sense of perspectiveor transcendence that brought comfort and peace.The propensity for natural environments to aidrecovery from negative emotions and stress has beennoted by several previous studies—although nonespecifically on older people—(Ulrich et al., 1991;Parsons et al., 1998; Korpela, 2003), with particularemotional benefits found for people coping withhealth complaints (Korpela and Ylen, 2007).

In addition to scenic vistas, views of vegetationand plants were much enjoyed. Several intervieweeshad favourite trees that they could see from theirwindows:

So I’m quite fond of this shrub, tree, across theroad here. I was speaking to the man yesterdayand telling him once again how much I appre-ciated it. It’s across that way. It’s beautiful andit’s so well pruned.[Woman, 80s, Coastal Town]

One interviewee in the Inner City Neighbourhoodoverlooked the park, and although she did not gointo it much, she described in detail how shewatched the changing seasons from her window,and the order in which different plants and flowerscame into leaf and bloomed. Views of neighbours’gardens and public green spaces were very impor-tant for those who were not very mobile. BothMoore (1981) and Ulrich (1984) have postulatedhealth benefits of pleasant natural views to peopleconfined indoors: in those cases, prisoners andhospital patients, respectively.

The Coastal Town has the advantage of the seaviews, and the Suburban Estate has quite openaspects with views of the mountains for some; theInner City Neighbourhood was the least advantagedin this respect. Interviewees in the Inner CityNeighbourhood, however voiced strong opinionsabout the need for having beauty, especially nature,around them. This need not be on a large scale.Flower tubs recently placed by the council close tothe main local shopping area were very popular.Some interviewees kept window boxes, or tendedplants in the communal spaces such as stairwellsand bin areas. These were seen as a symbol of pridein one’s own environment, as well as a source ofaesthetic pleasure. The importance of having thesein such an inner city neighbourhood was stressed—if anything, they were felt to be more important dueto the surrounding poor quality and stressfulness ofthe environment (see also Kuo, 2001).

Interviewer: Why [did you say that] flowers andgardens are important?Participant: It just makes you feel you arenotywhen I was young it was just all dirt andgrime if you like, I mean we all burnt coal, youhad the [industry], even the hospital used to befull of smoke and all that.ybut even then we stillhad nice flowers. And I think it brings you backto nature and makes you realise that there ismore to life. Even just sitting watching flowers,looking at the flowers, the different colours, thedifferent shapes of petals and all that, you couldspend ages.[Woman, 70s, Inner City Neighbourhood].

It just makes youyit really makes you feelbetter, seeing a bit of greenery, it needn’t be greatbig trees, it could be, something to take away thegreyness you know?[Woman, 70s, Suburban Estate, previous residentof the Inner City Neighbourhood]

Discussion and conclusions

Working from the discussions with older peopleand with further evidence from observing theirpractices, it has been possible to identify severaldimensions of the local outdoor environment thatthey experience, and theorise, as impacting on theirhealth, for better or for worse. These dimensionshave been summarised here as cleanliness, peace-fulness, exercise facilitation, social interaction facil-itation, and emotional boost. An environment thatis poor on any of these dimensions will challengeolder people, whilst one rating well on thesedimensions will support older people.

Overall, the dimensions of most importance wereperhaps social facilitation and exercise facilitation,although individuals varied in their needs dependingon their circumstances at any given time. However itis important to emphasise that all the dimensionsconnect and overlap. An environment that is easilynegotiated by pedestrians enables greater informalsocialising out of doors; an environment that isclean, aesthetically pleasant and uplifting alsoattracts people outside, to exercise and socialise.This is not, however, intended as an argument forsimple environmental determinism—whilst the phy-sical configuration may make walking and socialis-ing more or less easy, there is no evidence here thatit could create a community dynamic.

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But to what extent are these dimensions distinc-

tive to older people? As noted at the start, oneinterest of this study was in exploring the possibilityof an environmental inequity existing within spa-tially defined communities, in that some aspectscould offer a greater challenge to older people thanto others. The counterpart to this is that there maybe positive qualities that benefit older people morethan others. Several authors have argued thatenvironments that provide a good quality of lifefor older people are also likely to benefit other agegroups (Carp, 1987; Feldman and Oberlink, 2003;Phillips et al., 2005). Without having incorporatedthe views of others in this study, it is not possible tobe conclusive, but there are grounds for arguing acertain age specificity at a population level, at leastin degree of effect. Perhaps the clearest case isregarding the physical configuration that can affectmobility, as well as the location of services. Severalinterviewees also felt that quietness was moreimportant with age. Pollution affects everyone, butmight affect older people more, especially if theyhave lung or heart conditions—as explained bysome participants, and also according to govern-ment health advice (DEFRA, 2002). The supportand mental health benefits provided by socialcontact and also by a comforting and upliftingenvironment that allows a sense of transcendence,may also be crucial to older people at risk ofisolation and depression. Where an environment isdifficult to walk around, noisy, polluted, lacking innatural elements and greenery, or poorly servicedwith transport, shops, toilets, and seats, therefore,an injustice with respect to older people is poten-tially in effect—whether or not such aspects affectothers too.

A further dimension of inequity is that whichmight occur between places. Whilst this study ofthree localities cannot provide an analysis of widerdistributional patterns, it does provide an illustra-tion of how the situation might vary with place. Inthis case, in terms of the features discussed, theSmall Coastal Town emerged as the most advanta-geous environment overall, the Inner City Neigh-bourhood emerged the most problematic, and theSuburban Estate somewhere in between, althoughthis ranking would not hold with respect to everyindividual feature. Such inequity might followpatterns linked to overall socio-economic status,or could be connected with the type of place—innercity, suburban, and semi-rural. As the dimensionsare multiple, so the routes to inequitable situations

involve different processes and actors. However, ifthe inequity between places does broadly followsocio-economic patterns, it is likely to compounddisparities already apparent among older adults,such as socio-economic differences in overall healthstatus (Grundy and Holt, 2001) and in incidence ofdisability (Grundy and Glaser, 2000).

Maximising the potential contribution of theenvironment to older adult health—and minimisingits negative impact—must, it seems, involve anumber of actors and sectors. Planners andurban designers are clearly key, in designing andapproving street layouts, service provision andlocation, the siting of facilities for older people,traffic management regimes, and street furniture.Agencies responsible for maintenance of paths,pavements and public spaces have an importantrole too. Cleansing services should strive for highstandards in all places. Government and localauthority regulation of air quality and environ-mental noise will benefit older people. Attentionshould be paid to overall aesthetics and to theincorporation in the local environment of plants,flowers, and other natural elements where possibleand schemes to do so could involve the public,private, and voluntary sectors.

As with all case study research, the findings of thisstudy are to some degree context specific, althoughsupported by evidence from other studies. Otherparticipants in other places might identify furtherimportant environmental features—no-one in thisstudy, for example, talked about pedestrian cross-ings (see e.g. Richard et al., 2005; Hanson andEmlet, 2006), or about street lighting. Preciselybecause of the diversity of individuals, three smallcase studies could not be expected to describedefinitively the characteristics of the ideal environ-ment for older people, but nevertheless the fivedimensions identified offer a broad framework forapproaching the subject in other locations.

This study has focused on the outdoor physicalenvironment, and has not addressed the widercontextual social dynamics of the case study areas.It must be acknowledged that issues connected withthe behaviour of other people were relevant to theparticipants’ use of the local environment; these arediscussed elsewhere (contact author for details).This article has also not addressed the relevant issueof older people’s involvement in decisions regardingtheir local environment—again, this is discussedelsewhere, and is an issue that would benefit fromfurther research.

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Finally, it should be pointed out that olderpeople, although perhaps spending more time intheir local environment, are not confined to it. Allparticipants in this study enjoyed visits to otherplaces. A good quality environment benefits morepeople than its residents, and if appropriate,inclusive transport strategies are in place, cancontribute to even those older people residing inless-advantaged places enjoying a better environ-mental quality of life.

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