Engaging older adults as advocates for age-friendly, walkable communities: The Senior Change Makers Pilot Study

Christina M Patch, Terry L Conway, Jacqueline Kerr, Elva M Arredondo, Susan Levy, Chad Spoon, Katie J Butte, Deepa Sannidhi, Rachel A Millstein, Danielle Glorioso, Dilip V Jeste, James F Sallis, Christina M Patch, Terry L Conway, Jacqueline Kerr, Elva M Arredondo, Susan Levy, Chad Spoon, Katie J Butte, Deepa Sannidhi, Rachel A Millstein, Danielle Glorioso, Dilip V Jeste, James F Sallis

Abstract

As the U.S. population ages, communities must adapt to help older adults thrive. Built environment features, like safe sidewalks and crosswalks, provide the foundation for age- and physical activity-friendly communities. Controlled studies are needed to evaluate advocacy training programs that instruct and support seniors to advocate for more walkable neighborhoods. The Senior Change Makers Pilot Study evaluated an advocacy program that taught seniors to evaluate pedestrian environments using the validated MAPS-Mini audit tool, identify barriers, and advocate for improvements. Participants (n = 50) were recruited from four low-income senior housing sites in San Diego, CA, which were randomly assigned to an 8-week advocacy program or physical activity (PA) comparison intervention. Evaluation included surveys, accelerometers to assess PA, and direct observation. Primary outcomes were seniors' advocacy confidence and skills. Main analyses used repeated measures ANOVAs. Seniors in the advocacy condition (n = 17) increased their advocacy outcome efficacy (p = .03) and knowledge of resources (p = .04) more than seniors in the PA condition (n = 33). Most seniors in the advocacy condition completed a street audit (84%), submitted an advocacy request (79%), or made an advocacy presentation to city staff (58%). Environmental changes included repairs to sidewalks and crosswalks. City staff approved requests for lighting, curb cuts, and crosswalk markings. Seniors' accelerometer-measured PA did not significantly increase, but self-reported transportation activity increased in the PA condition (p = .04). This study showed the potential of advocacy training to empower seniors to make communities more age- and activity-friendly.

Trial registration: ClinicalTrials.gov NCT02944838.

Keywords: Age-friendly; Built environment; Exercise; Older adult; Policy; Walkability; Walking.

© The Author(s) 2021. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.

Figures

Fig 1
Fig 1
CONSORT flow diagram of participants.

References

    1. World Health Organization. Global strategy and actionplan on ageing and health.2017. Retrieved November 18, 2020, from
    1. Jeste DV, Blazer DG 2nd, Buckwalter KC, et al. . Age-friendly communities initiative: public health approach to promoting successful aging. Am J Geriatr Psychiatry. 2016;24(12):1158–1170.
    1. Chou CH, Hwang CL, Wu YT. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Arch Phys Med Rehabil. 2012;93(2):237–244.
    1. U.S. Department of Health and Human Services. Physical activity guidelines for Americans, 2nd ed. 2018. Retrieved November 18, 2020, from
    1. Hupin D, Roche F, Gremeaux V, et al. . Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged ≥60 years: a systematic review and meta-analysis. Br J Sports Med. 2015;49(19):1262–1267.
    1. Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–188.
    1. Barnett DW, Barnett A, Nathan A, Van Cauwenberg J, Cerin E; Council on Environment and Physical Activity (CEPA) – Older Adults working group . Built environmental correlates of older adults’ total physical activity and walking: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2017;14(1):103.
    1. Cain KL, Millstein RA, Sallis JF, et al. . Contribution of streetscape audits to explanation of physical activity in four age groups based on the Microscale Audit of Pedestrian Streetscapes (MAPS). Soc Sci Med. 2014;116:82–92.
    1. Cerin E, Nathan A, van Cauwenberg J, Barnett DW, Barnett A; Council on Environment and Physical Activity (CEPA) – Older Adults working group . The neighbourhood physical environment and active travel in older adults: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2017;14(1):15.
    1. Thornton CM, Kerr J, Conway TL, et al. . Physical activity in older adults: an ecological approach. Ann Behav Med. 2017;51(2):159–169.
    1. Van Cauwenberg J, Nathan A, Barnett A, Barnett DW, Cerin E; Council on Environment and Physical Activity (CEPA)-Older Adults Working Group . Relationships between neighbourhood physical environmental attributes and older adults’ leisure-time physical activity: a systematic review and meta-analysis. Sports Med. 2018;48(7):1635–1660.
    1. King AC, King DK, Banchoff A, et al. . Employing participatory citizen science methods to promote age-friendly environments worldwide. Int J Environ Res Public Health. 2020;17(5):1541.
    1. U.S. Department of Health and Human Services. Step it up! The Surgeon General’s call to action to promote walking and walkable communities. 2016. Retrieved November 18, 2020, from
    1. Buman MP, Winter SJ, Baker C, Hekler EB, Otten JJ, King AC. Neighborhood Eating and Activity Advocacy Teams (NEAAT): engaging older adults in policy activities to improve food and physical environments. Transl Behav Med. 2012;2(2):249–253.
    1. Corrado AM, Benjamin-Thomas TE, McGrath C, Hand C, Laliberte Rudman D. Participatory action research with older adults: a critical interpretive synthesis. Gerontologist. 2020;60(5): e413–e427.
    1. Mather M, Scommegna P.. Today’s Research on Aging: How Neighborhoods Affect the Health and Well-Being of Older Americans. Washington, DC: Population Reference Bureau; 2017. Retrieved November 8, 2020, from .
    1. Sallis JF, Cain KL, Conway TL, et al. . Is your neighborhood designed to support physical activity? A brief streetscape audit tool. Prev Chronic Dis. 2015;12:E141.
    1. Botchwey N, Jones-Bynes J, O’Connell K, Millstein RA, Kim A, Conway TL. Impact of a youth advocacy policy, systems and environmental change program for physical activity on perceptions and beliefs. Prev Med. 2020;136:106077.
    1. Sallis JF, Owen N, Fisher E. Ecological models of health behavior. Health Behav Theor Res Pract. 2015;5:43–64.
    1. Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice Hall; 1986.
    1. Zimmerman MA, Rappaport J. Citizen participation, perceived control, and psychological empowerment. Am J Community Psychol. 1988;16(5):725–750.
    1. Rich P, Aarons GA, Takemoto M, et al. . Implementation-effectiveness trial of an ecological intervention for physical activity in ethnically diverse low income senior centers. BMC Public Health. 2017;18(1):29.
    1. Millstein RA, Woodruff SI, Linton LS, Edwards CC, Sallis JF. Development of measures to evaluate youth advocacy for obesity prevention. Int J Behav Nutr Phys Act. 2016;13:84.
    1. Coffman J, Hendricks A, Kaye JW, Kelly T, Masters B. The advocacy and policy change composite logic model. 2007. Retrieved November 8, 2020 from
    1. Tomioka K, Iwamoto J, Saeki K, Okamoto N. Reliability and validity of the International Physical Activity Questionnaire (IPAQ) in elderly adults: The Fujiwara-Kyo Study. J Epidemiol. 2011;21(6):459–465.
    1. Linnan L, Steckler A.. Process Evaluation for Public Health Interventions and Research. San Francisco, CA: Jossey-Bass; 2002.
    1. Marcoux MF, Sallis JF, McKenzie TL, Marshall S, Armstrong CA, Goggin KJ. Process evaluation of a physical activity self-management program for children: SPARK. Psychol Health. 1999;14(4):659–677.
    1. Kirwan M, Duncan MJ, Vandelanotte C, Mummery WK. Design, development, and formative evaluation of a smartphone application for recording and monitoring physical activity levels: the 10,000 steps “iStepLog.” Health Educ Behav. 40(2):140–151.
    1. King AC, Sallis JF, Frank LD, et al. . Aging in neighborhoods differing in walkability and income: associations with physical activity and obesity in older adults. Soc Sci Med. 2011;73(10):1525–1533.
    1. Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc. 1998;30(5):777–781.
    1. Keadle SK, McKinnon R, Graubard BI, Troiano RP. Prevalence and trends in physical activity among older adults in the United States: a comparison across three national surveys. Prev Med. 2016; 89:37–43.
    1. Millstein RA, Woodruff SI, Linton LS, Edwards CC, Sallis JF. A pilot study evaluating the effects of a youth advocacy program on youth readiness to advocate for environment and policy changes for obesity prevention. Transl Behav Med. 2016;6(4):648–658.
    1. Lee EE, Depp C, Palmer BW, et al. . High prevalence and adverse health effects of loneliness in community-dwelling adults across the lifespan: role of wisdom as a protective factor. Int Psychogeriatr. 2019;31(10):1447–1462.
    1. Mama SK, Leach HJ, Soltero EG, Lee RE. Improved physical activity screening enhances intervention effectiveness in ethnic minority women: a longitudinal study. Health Promot Pract. 2017;18(1):54–61.
    1. Clemes SA, Deans NK. Presence and duration of reactivity to pedometers in adults. Med Sci Sports Exerc. 2012;44(6):1097–1101.
    1. Buman MP, Hekler EB, Haskell WL, et al. . Objective light-intensity physical activity associations with rated health in older adults. Am J Epidemiol. 2010;172(10):1155–1165.
    1. Ivers NM, Halperin IJ, Barnsley J, et al. . Allocation techniques for balance at baseline in cluster randomized trials: a methodological review. Trials. 2012;13:120.

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