Age-Friendly Communities Initiative: Public Health Approach to Promoting Successful Aging

D uring the coming years, the United States will experience a dramatic growth in the population over age 65, from the current 49 million to a projected 84 million seniors by 2050.1 The rapid increase in the aging population is overwhelming the national infrastructure for physical and mental healthcare.2 Limitations of the present geriatric healthcare system include inconsistent and often poor availability, access, and affordability of the necessary physical and mental health services along with a worsening shortage of geriatric healthcare providers.3 Consequently, a rethinking of policies at national and local levels is underway. Emphasis will need to shift from the current costly and unsustainable methods in which healthcare-related services are provided to efficiency and preventive care. This will involve a paradigm shift for geriatrics and geriatric psychiatry, away from the sole focus on delivery of interventions at individual level to more prevention-focused, communitybased approaches. American Association of Retired Persons (AARP) surveys show that most seniors want to stay in their own homes instead of moving to an assisted living or nursing facility, even when they are disabled.4 This would require creating conditions that are necessary to enable aging-in-place, including formal and informal support systems in the community.5 In recent years, several age-friendly community (AFC) initiatives have been launched, with the aim of promoting physical and psychosocial well-being of older residents and improving the quality of life of the entire community. The AFCs1 incorporate all aspects of the natural, built, and social environment and are “places where older people are actively involved, valued, and supported with infrastructure and services that effectively accommodate their needs.”6 (p.4) However, until recently the field of geriatric psychiatry has not been involved to a significant extent in the development of AFCs. It is critical that mental healthcare be considered and delivered on par with physical healthcare for promoting healthy aging. The goal of this article is to inform geriatric psychiatry practitioners about AFCs and also push the field into new territory, that is, enhancing conversation and collaboration between the people developing AFCs and mental healthcare providers. Presently, the community development system and the mental healthcare system occupy different “silos.” AFC development provides opportunities for breaking these silos and synergizing those systems to benefit seniors. The transformative shift for geriatric psychiatry will involve rethinking how care is delivered and also how the specialty can become a driving force toward the formation of AFCs. This can aid in translating the science of psychosocial resilience, well-being, and healthy aging into a new and evolving “positive psychiatry” of aging7–10 on a public health scale. Positive mental health outcomes are associated with longer life, better health, and greater productivity,11–14 and AFCs seek the same goals at the community level. This article provides a brief historical background, discusses the conceptualization of the AFC, offers a list of criteria of an AFC, narrates case studies of AFCs in various stages of development, summarizes challenges to becoming age-friendly that communities commonly face, and suggests solutions to those problems.