A scoping review protocol of age-friendly practices during the COVID-19 pandemic

Introduction

The COVID-19 pandemic has exposed the fragility and resilience of the services and resources that support older people’s health and well-being such as health-care, social protection, long-term care, information and financial systems¹. Older people are considered at high risk from COVID-19 as chronological age has been shown to be associated with increased risk of developing severe illness if infected, which has led to the highest mortality rate among this age group^2,3. Moreover, the public health measures necessary to contain the spread of the virus, including shelter-in-place recommendations, physical distancing, and closure of third spaces, such as community halls, places of worship, libraries and outdoor public places, have significantly influenced the routines of many older individuals globally^4–6. For some older people, these disruptions have been met with periods of adaptation and successful implementation of coping strategies^7,8. However, those facing a high degree of disruption or lacking adequate support may experience long-term consequences in their physical, mental and/or social well-being⁴. Although individual characteristics have been shown to be significant predictors for these outcomes, emerging evidence indicates that socio-ecological factors embedded at multiple levels of influence play a key role in driving experiences of health and well-being during the COVID-19 pandemic^9–16.

Previously established theoretical perspectives rooted in the field of environmental gerontology recognize ageing as a widely heterogeneous experience and highlight that the benefits of specific environments relate to how well they suit the shifting needs and capabilities of a certain individual through the life-course^17,18. In the context of COVID-19, the physical, social, and economic environments where people were nested before and throughout the public health crisis have shaped individual’s everyday life and determined what they can be and do, given their intrinsic capacities both during and beyond the pandemic. The intrinsic capacity is all the physical and mental capabilities of an individual, divided in five main domains: vitality, sensorial (i.e., visual and hearing), cognitive, locomotor and psychological capacities^19,20. The intersection between an individual’s intrinsic capacity, the characteristics of their environment and how individuals interact with it determine their functional ability²¹. Functional ability is defined by the opportunities for an individual to be and do what they deem valuable- that is the ability to meet their basic needs, maintain independence, complete every day valued tasks, build and maintain relationships with others, and contribute to society²¹. According to the World Health Organization (WHO), intrinsic capacity, environments, and functional ability constitute the 3 components necessary to promote and maintain healthy ageing²².

Significantly, public health crises such as COVID-19 can block access to valuable health enabling resources leading to an accelerated decline towards poor health and exacerbation of inequalities in healthy ageing, particularly among vulnerable sub-groups of older people⁴. The inequalities highlighted by the pandemic and challenges presented raise fundamental questions about the responses needed to support older people during public health crises²³. Given the potential of prominent environments such as home, neighbourhood and local community to exert an influence on healthy aging and the delivery of services for older people in these circumstances, a multi-disciplinary approach is needed for the development and implementation of appropriate policies and interventions, considered as age-friendly practices. The development of such age-friendly practices requires actions in multiple sectors, and calls for multi-stakeholder engagement that includes older people, multiple levels of government, service providers, civil society, community groups, and friends and families^24,36.

Responding to the need for guidance to develop appropriate approaches, in 2007 the WHO published a guide for cities to develop age-friendly cities and communities based on a framework of 8 interconnected domains: (1) outdoor spaces and infrastructure; (2) transportation; (3) housing; (4) social participation; (5) respect and social inclusion; (6) civic participation and employment; (7) communication and information; and, (8) community support and health services²⁵. Following the publication of the age-friendly cities guide, in 2010 the WHO launched the Global Network for Age-Friendly Cities and Communities with the objective of building a platform of shared experiences around the globe and catalysing progress through political commitment, planning, action and evaluation of age-friendly practices²⁴. Later in 2015, the WHO’s Age-Friendly framework was expanded to emphasize a broader notion of age-friendly environments encompassing urban, rural, and suburban communities²⁴.

The development of appropriate responses to rapidly changing environments due to COVID-19 has required adaptation of existing support strategies and leveraging of existing infrastructure in cities and communities¹⁹. Evidence of feasible and accessible age-friendly practices during the pandemic is emerging from the Global Network of Age-Friendly Cities and Communities^26–28. Such evidence has the potential to increase the quality of planning of concrete age-friendly actions during current and future public health emergencies²⁶. However, to our knowledge a comprehensive review of age-friendly practices during the COVID-19 pandemic has not been carried out to date, and synergies with other public health and environmental interventions remain unexplored. Thus, the objective of our scoping review will be to investigate the development, implementation, and evaluation of age-friendly practices during COVID-19. The aim of this paper is to present a protocol for the proposed scoping review by detailing our objectives, methods, and plans for reporting results. Publication of this protocol allows for transparency of the review process, and it also reduces the potential for duplication, facilitates peer review of the planned methodology before it is carried out, and offers the researchers the opportunity to plan the resources and logistics necessary to complete the review^29,30.

Methods

Methods will be based on the Joanna Briggs Institute (JBI) guidance for conducting a scoping review³¹. A scoping review is defined as “a form of knowledge synthesis that addresses an exploratory research question aimed at mapping key concepts, types of evidence, and gaps in research related to a defined area or field by systematically searching, selecting, and synthesizing existing knowledge”³². A scoping review was chosen to ascertain the diverse approaches that may be represented across the multi-dimensional domains that comprise age-friendly environments within the existing international literature. This approach will allow us to characterize the interventions and support strategies developed across the 8 domains of the age-friendly framework, which may differ widely in delivery methods, resources needed and adaptative strategies deployed during the pandemic. An additional benefit of our scoping review is that we will consider practices and interventions that may provide innovative age-friendly approaches but that are conducted outside the global network of age-friendly cities and communities. This approach may identify potential synergies with other public health and environmental interventions that promote the development of health enabling environments, such as healthy cities³³, future- and age-ready cities^34,35, and sustainable cities³⁶.

A comprehensive search strategy will be utilised to identify experiences on the development, adaptation and implementation of age-friendly support strategies and interventions during the COVID-19 pandemic from electronic databases, grey literature sources, and reference list screening of publications dating from January 2020 to date. The research questions that our scoping review seeks to address are:

Discussion

This protocol allows for transparency in the process of a scoping review focused on age-friendly practices during COVID-19, as it pre-defines our objectives, methods, and plans for reporting of results²⁹. Additionally, we have detailed our inclusion and exclusion criteria, approach to identify relevant data and how the data will be extracted. In line with JBI guidance, any deviations of the scoping review from the protocol will be clearly highlighted and explained in the publication of results from the scoping review²⁹. The publication of the protocol is important in limiting the occurrence of reporting bias and may also be a useful tool for other researchers preparing projects of evidence-synthesis related to healthy ageing and/or age-friendly practices. As data, research and innovation are among the enablers of the Decade of Healthy Ageing⁴², providing detailed information on the methodologies to be used may also support the development of further research by identifying research priorities and gaps in evidence. Moreover, our project responds to the Decade of Healthy Ageing call for synthesis of evidence that has potential to benefit older people, their families, and communities and that also facilitates sharing of experiences and ways to scale up good practices to reach more people⁴².

Evidence emerging from the scoping review proposed in this protocol has the potential to support age-friendly cities and communities by summarizing the experiences of development and implementation of practices across multiple age-friendly domains in the context of the COVID-19 pandemic. This information may facilitate the total or partial replication of age-friendly practices in new contexts. Additionally, it may underscore gaps and opportunities for policies, environmental interventions and public health programmes needed to support older people. Lessons drawn from the development and implementation of age-friendly practices during COVID-19 also provide useful insights for multisectoral collaborations and the development of future emergency preparedness plans.

For instance, the adaptation of age-friendly initiatives established previous to the pandemic may facilitate a fast mobilization of community networks that work alongside older people to maintain the functioning that are most valuable to them even during the context of the COVID-19 pandemic²⁶. Significant scope also exists for the development of new innovative strategies that are low-cost and may be implemented in multiple settings including those characterized by low availability of human and/or financial resources. It is also relevant to identify practices that do not self-identify as age-friendly but may share a vision of promoting health enabling environments for all through the life-course. This will allow to identify potential synergies between existing programs and build further collaboration towards resilient systems that leave no-one behind. It is likely that age-friendly practices will become increasingly significant in an ageing world that is facing the opportunities and challenges brought-up by parallel trends of increasing urbanization, environmental degradation and rise of infectious disease outbreaks.

Conclusion

This protocol presents our plans for a scoping review that will contribute to the evidence base of age-friendly practices developed during the COVID-19 pandemic. The protocol sets up the context and methods within which the review will be carried out and facilitates a systematic and transparent process that will minimize risk of bias and allow the research team to define next steps accordingly. Moreover, the publication of the scoping review protocol may provide further guidance to researchers interested in developing similar approaches that follow a systematic evidence-based strategy. We consider findings emerging from the scoping review proposed will inform the development of age-friendly practices across the globe and guide future research that seeks to address knowledge gaps concerning interventions for older people in emergency situations and beyond.

Ethics

Ethical approval will not be needed as the scoping review outlined within this protocol will use publicly available literature.