In an ageing country without nursing homes and with fewer and fewer care staff, we will have to look for ways to grow old healthily in our own neighbourhood. What do we need to make this happen? Safety, a social network and neighbours who help each other out are key factors for age-friendly communities, says prof. dr. Jane Murray Cramm, professor of person-centred care at Erasmus School of Health Policy & Management (ESHPM) and Chief Diversity Officer at Erasmus University Rotterdam.
The research by prof. dr. Jane Murray Cramm and prof. dr. Anna Petra Nieboer focuses on age-friendly communities. The need for these communities has never been greater, in a society where we increasingly have to take care of ourselves and where people (have to) live at home until later in life. But what does (living in) an age-friendly community entail? Are there differences between the wishes of older people with and without migration backgrounds? And how can we create neighbourhoods that support the well-being of all?
Inviting people to tell their own stories about what they need
Prof. dr. Jane Murray Cramm: 'We do research into what people need, and we let people tell us about their wishes and needs themselves. We are conducting several studies on this topic at the moment. In two studies, we are working together with the municipality of Rotterdam and with the municipality of Drechtsteden, to research the influence of neighbourhoods on healthy lifestyles and residents' health. Another large-scale study focuses on the four big cities in the Netherlands: Rotterdam, Amsterdam, The Hague and Utrecht. In this study, we research differences between people with and without migration backgrounds.
There are quite a few differences between people, depending on health, social network, financial resources, needs, background. We conduct the survey among people of Dutch, Moroccan, Turkish, and Surinamese descent. In the four big cities, these are the largest groups. We conduct both qualitative and quantitative research among all these groups.'
Personal drive
Cramm: 'Socio-economic differences in the Netherlands continue to increase. People can die up to six years earlier, depending on where they grow up. Or people spend the last 15 years of their lives in poorer quality. I think that is very sad. On top of that, I think we are missing certain groups of people in research on this topic. Because it might be harder to do research among these groups. Yes, it is more difficult sometimes to include certain groups. But that's where it gets interesting for me.'
How do you make sure you have a diverse group of respondents?
Cramm: 'To start with, we work with a diverse research team, with researchers with Surinamese, Turkish, Dutch and Egyptian backgrounds. It is important that you have different perspectives right from the beginning of your research process. We visit people's homes with two bilingual researchers with a questionnaire. We have these questionnaires in Dutch and Arabic, among other languages. We try to make it as approachable and accessible as possible.
We find that the response rate is initially higher among people without a migration background. This has a lot to do with trust. Some people only open the door when they recognise someone. Or people want to consult with their children first. It is sometimes quite an intensive process. Sometimes you stay with someone for an hour and a half to go through the questionnaire together. So that happens during the quantitative part of the research. In addition to that, the qualitative part of the research runs.
We take our time with respondents. We leave our phone number if they want to think about it. We visit them again. This makes this research take more time (and cost more money). We have taken that into account and we consciously invest in that as well.'
First results: safety and social network are of great importance
Cramm: 'We haven't done all the analyses yet, but we can already offer some insights into how to age healthily in your own neighbourhood. We clearly see that safety is very important. For many, this even counts as a precondition. There are many neighbourhoods in big cities where incidents and explosions are on the rise. Safety is number one then, especially if you are vulnerable and of older age. Because if there is something going on, you cannot just run away. In some neighbourhoods, older people feel they cannot go outside safely. This truly hinders them in their daily lives.
Another insight is that there is a need for more social cohesion, for more contact between different groups as well. Isn't it actually crazy that in the Netherlands we have to hire home care to drip eyes or put on support stockings? Could a fellow neighbour help? And not just for instrumental help, but also for a chat, or for help with complicated letters. Our healthcare system in the Netherlands is so complex. People do not always understand information they receive. If neighbours could help each other with certain tasks and with complicated letters or forms, that would be amazing.'
Differences between Dutch people with and without migration background
Cramm: 'Regarding differences between Dutch people with and without migration background, we have not yet done the overall analysis. We have so far mainly looked within the groups. In general terms, I can say that sometimes the differences between people lie more in (not) having a social network than whether one has a migration background or not.
What we generally see is that if people have a social network, they are less dependent on care and/or their neighbours. Without a social network, the neighbourhood becomes a lot more important. Within the group of older people with a Turkish background, it is striking that they score high on social well-being. This has to do with the fact that older people in Turkish families have a very high status. In Surinamese families, too, the strong family ties are striking. Cooking together, for instance, is very important there. Furthermore, we see a lot of loneliness among Dutch people without a migration background, while you often read in literature that they do relatively better than older people with a migration background.'
Age-friendly communities
Cramm: 'There is a lot of social interaction within groups but not so much between them. While more interaction between groups is often very positive, as we know from earlier research and literature. Age-friendly communities focus on a safe environment that is inviting for older people, where there is more interaction between different groups (young and old, groups with diverse cultural backgrounds). The motto is: do not build standard nursing homes, but choose other forms of living together, aimed at more togetherness. Make it more inviting, make it easy for people to cook together. Older and younger people often have the same needs in terms of living: a small space to live in, and a communal space to cook, to get together.
There are more and more single people in the Netherlands, young and old, with diverse backgrounds. Why don't they connect more? It may have to do with barriers people feel to approach each other, or because people do not date to ask for help. This should become something natural in a neighbourhood community. Provide low-threshold living arrangements with lots of togetherness. That makes a community age-friendly.'
Role of municipalities and neighbourhoods
Cramm: 'We work together well with various municipalities. We draw up the research questions together - creating truly engaged research. The advices that emerge are often very concrete, and very simple things. For older people, for example, it is important that the municipality clears the leaves quickly, if they have fallen in autumn. Another concrete advice could be leaving traffic lights on green longer at certain pedestrian crossings.
Sometimes you also have to look at what overarching needs there are. Not everyone needs the same thing. Take a good look at where the needs of different groups lie and try to focus on groups that need (more) help.
It is very nice to see that municipalities and policymakers are open to our findings. In Rotterdam, we work with an integrated neighbourhood approach. We as researchers meet once every two months with the municipality of Rotterdam where we share our latest findings. We always get very open and spontaneous reactions: "Ooooh, this is something this team really needs to hear". This also leads to better cooperation between departments and parties within the municipality.'
Keeping in touch with respondents about the research
Cramm: 'We think it is very important to keep respondents informed about our research. We are now working on a poster where we share our results in an accessible way. With lots of drawings to explain certain things. We want to give back what we have learned. This is really our responsibility as researchers.'
In what way is your research related to your role as Chief Diversity Officer?
Cramm: 'This is just Jane. This comes frosm within. Inclusion is so important, I really want to achieve that as a person. As Chief Diversity Officer, I am gathering even more knowledge. And my work as a researcher also offers new insights every time. It really reinforces each other.'
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- Creating age friendly communities for all
