Accessibility and quality of urban green spaces to promote physical activity among urban older adults

Abstract

AbstractRegular physical activity (PA) is essential for healthy aging, offering numerous health benefits such as a reduced risk of chronic diseases, improved mental health, and enhanced independence and cognitive function in older adults. Despite these benefits, significant portions of the global and U.S. older adult populations remain physically inactive, contributing to increased healthcare costs and mortality. With over half of the global population now living in urban areas and the number of older adults in cities rapidly rising, ensuring access to safe and inclusive places for PA is critical. Urban green spaces (UGS), including parks, gardens, and greenways, are vital components of city infrastructure that promote physical activity, mental well-being, and social interaction, particularly among older adults. While research confirms their positive impact, ensuring that these spaces are inclusive and accessible to all age groups, especially older adults, is essential. Qualities such as size, proximity, maintenance, and available amenities significantly influence how older adults use these spaces. The overall goal of this dissertation was to examine how the accessibility and quality of UGS influence PA behavior among older adults, aiming to enhance access, promote active aging, and inform age-friendly initiatives in Honolulu. This dissertation reports on three studies to achieve this goal. Study 1 was a systematic review of peer-reviewed articles published between 2015 and 2024 that explored UGS qualities that enhance accessibility and promote PA among older adults globally. Although the review found limited examination of the relationship between PA and UGS quality among older adults, existing articles generally reported positive relationships between UGS qualities and PA. For example, UGS land cover, trail length, activity areas, and availability of outdoor fitness equipment were positively related to older adults' PA levels in parks. The limitations of the studies were that none incorporated qualitative methods to gather in-depth insights into the park's qualities and to understand which qualities are most desired by older adults. Study 2 aimed to explore older adults’ preferences for park qualities that enhance accessibility and support PA using the Photovoice method. Seven senior club members in Honolulu participated in photo-taking, and five joining a focus group discussion. Important UGS qualities identified through the Photovoice discussion included safety, paved walkways, shaded seating, clean restrooms, adequate parking, proper signage, ramps, open spaces, and overall park maintenance. Participants ranked these qualities according to their importance for engaging in PA in parks, with safety as the top priority. Drawing on Studies 1 and 2, Study 3 developed a method to create a UGS accessibility score. The extent to which Honolulu's UGSs (parks) met the spatial accessibility and age-friendly infrastructure criteria that encourage PA among older adults was explored using publicly available data, GIS technology, and Photovoice participants’ rankings. In general, district parks scored higher than mini parks, beach parks, and regional parks. The findings from this dissertation can guide funding priorities for improving parks in underserved areas and support zoning and transportation policies to enhance older adult’s connectivity to UGS. GIS-based tools can help older adults, caregivers, and service providers identify parks that meet specific needs, such as accessible paths, shaded seating, and safety features, enabling informed decisions based on mobility and preferences.