Innovative solutions to enhance safe and green environments for ageing well using co-design through Patient and Public Involvement.

Background: There is a need to develop innovative solutions to enhance safe and green physical environments, which optimise health, wellbeing and community participation among older adults. In order to develop solutions that meet the needs of a diverse ageing population, an interdisciplinary approach is needed. Our aim was to identify the needs of older people in relation to ageing well in the environment by bringing together knowledge from different perspectives using Patient and Public Involvement. Methods: An international consortium (Retrofit living For ageing well through Understanding and Redesign of Built environments consortium: ReFURB) was established in April 2018, including ten core members, to (i) explore cutting-edge solutions to safe living for ageing populations and (ii) develop innovative approaches to everyday physical environments, which bring about health benefits. We used a co-design, interdisciplinary framework involving older adults, carers, physiotherapists, geriatricians, engineers, human movement experts, geographers and psychologists from the UK and Australia. This engaged people in a one day workshop that comprised a series of presentations from international speakers on urban design, social connectedness, hazards and injury prevention, and the physical environment. Small group discussions (facilitated by consortium members) followed presentations to consider the opportunities, challenges and barriers encountered with ageing, which included the use of creative engagement activities (LEGO® Serious Play, mind maps, poster gallery walk), to help participants share personal stories and reflect on the issues raised. Thematic coding was used to synthesise the outputs of the small group work. Results: Five themes were identified across the workshops, comprising: access and transport; involvement of the whole community; restoration rather than redesign; assistive and digital technology; and intergenerational approaches. These dimensions related to the physical, social and nature-based qualities of everyday environments, as they pertain to ageing well. Conclusions: Co-design was a valuable tool that helped understand the perceptions of participants and essential to develop effective interventions and solutions. Participants highlighted several issues affecting people as they age and key environmental considerations to promote wellbeing, activity, and participation. The consortium identified gaps in the existing evidence base and are now planning activities to further develop research ideas in collaboration with our co-design participants.

Our everyday physical environments can pose challenges to maintaining a healthy and active lifestyle in later life. New solutions to improve the design, safety, and accessibility of diverse environments are needed to optimise health, wellbeing, activity, and community participation in older adults. Ten academics from two UK and Australian universities with expertise in these areas came together to develop novel solutions to enhance opportunities for safe and healthy living in old age. The group held a one day workshop for scholars from a range of disciplines, industry representatives, patients and older members of the public. The workshop began with presentations about urban design, social connectedness, injury prevention, and the natural environment. Participants were then involved in identifying research priorities within these topics, by sharing their ideas during small group discussions. Creative activities involving LEGO® bricks, mind maps and posters, were used to help participants share their personal experiences and provide feedback on issues raised in the talks. Together, the researchers and participants identified challenges to ‘ageing well’ and provided recommendations for possible solutions. Five main themes were identified, including access and transport; involvement of the whole community; restoration rather than redesign; assistive and digital technology; and intergenerational approaches. Older adults’ needs related to qualities of physical, social and natural environments. Feedback from participants during the workshop helped the group identify new challenges and solutions, which had not previously been considered. Findings from this work have informed the group’s future research activities, which will include collaboration and co-design with patients and members of the public.