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Greer, V. C., Hong, A., Canham, S. L., Agutter, J., Garcia, I., Van Natter, J. M., & Caylor, N. (2023). From Sheltered in Place to Thriving in Place: Pandemic Places of Aging. The Gerontologist.

The COVID-19 pandemic has necessitated rapid changes to the physical, social, and technological environments of older adults living independently. To understand how these individuals are adjusting to these transformations, a photovoice study was conducted to investigate how they characterize a "right" place to age. Our findings revealed that older adults prioritize places that foster identity, belonging, health, and personal fulfillment. Additionally, participants reported adapting their living spaces to accommodate increased technology use and outdoor time. These findings underscore the active role older adults play in shaping their environments and highlight the importance of place-based characteristics in promoting healthy aging during public health emergencies.


Greer, V., Canham, S. L., Hong, A., Agutter, J., Garcia Zambrana, I., & Van Natter, J. M. (2023). Aging in Place Through the COVID-19 Pandemic: Perspectives from Aging Service Providers. Journal of Applied Gerontology.

The COVID-19 pandemic has impacted the ability of aging-service providers to support older adults aging in place (AIP). This research presents findings from a series of World Cafe workshops conducted with aging-service providers in Salt Lake City, Utah. Our results identified new domains of support needed during the pandemic, including digital access and literacy, social isolation and mental health, and emergency preparedness. The pandemic also exacerbated socioeconomic and cultural disparities impacting older adults, highlighting the need for networks of advocacy and support to bolster resources for older adults, caregivers, and aging-service providers.

Greer, V., Canham, S. L., Hong, A., Caylor, N., & Van Natter, J. (2023). Shifting perspectives: outlooks on ageing in place in the COVID-19 era. Ageing & Society, 1-24.

This research investigated how the COVID-19 pandemic has impacted older adults' conceptions of aging in place. The study found that older adults now prioritize proximity to family and loved ones, the ability to balance safety and social connectivity, an increased appreciation for the outdoors, new platforms for learning, and the role of inner belief systems. These findings contribute to the ongoing discourse about aging in place and will continue to shape future policies on aging in place.


Hong, A., Welch-Stockton, J., Kim, J. Y., Canham, S. L., Greer, V., Sorweid, M. (2023) Age-friendly community interventions for health and social outcomes: A scoping review. International Journal of Environmental Research and Public Health.

To address the numerous challenges associated with aging, increased attention has been given to the development of age-friendly cities and communities (AFCC) to promote healthy aging and social participation. However, limited evidence exists for addressing both health and social needs through the AFCC framework. We address this gap by conducting a scoping review of the interventions that target both health and social outcomes within the purview of the AFCC framework. The results showed that many of the successful interventions used a partnership model and behavioral change theories to inform the program design and implementation. The results also indicated that social participation and engagement played a key role in making the interventions successful. However, the results revealed that the literature is dominated by person-focused approaches. Future research should focus more on evaluating environmental-focused interventions and develop a holistic framework that combines both person- and environment-based approaches to healthy aging.


Hong, Andy, Sallis, James F., King, Abby C., Conway, Terry, Saelens, Brian, Cain, Kelli, Fox, Eric, Frank, Lawrence. 2018. Linking green space to neighborhood social capital in older adults: The role of perceived safety. Social Science & Medicine, 207: 38-45.

This study examines the moderating effect of perceived safety on the association of green space with neighborhood social capital in older adults. Green space may play an important role for promoting neighborhood social capital and health for older adults; however, safety remains a significant challenge in maximizing the benefits of green space. Data were drawn from 647 independent-living seniors who participated in the Senior Neighborhood Quality of Life Study in the Seattle/King County and Baltimore/Washington DC region. The results suggest that certain green space elements, such as natural sights, may be beneficial to neighborhood social capital of older adults. However, other types of green space, such as parks and street trees, may be less advantageous to older adults who perceive their neighborhoods as unsafe for pedestrians. Findings highlight the importance of pedestrian safety in examining associations of green space with neighborhood social capital in older adults. Further studies using a longitudinal design are warranted to confirm the causality of the findings.


Fang, Mei Lan, Woolrych, Ryan, Sixsmith, Judith, Canham, Sarah, Battersby, Lupin, & Sixsmith, Andrew (2016). Place-making with older persons: Establishing sense-of-place through participatory community mapping workshops. Social Science & Medicine, 168, 223–229. 

Principles of aging-in-place emphasize the importance of creating sustainable environments that enable older people to maintain a sense of belonging, autonomy, independence, safety and security. Simply altering the built environment is insufficient for creating more inclusive environments for older persons, as creating ‘meaningful’ places for aging involves consideration of psychosocial and cultural issues that go beyond issues of physical space. This paper illustrates how applications of community-based participatory research methods, in particular, participatory community mapping workshops (PCMWs), can be used to access experiences of place, identify facilitators and barriers to accessing the built environment and co-create place-based solutions among older people and service providers in a new affordable housing development in Western Canada.


Increasing attention has been given to the role of green space in reducing health disparities. However, robust evidence to support decision making is lacking in the global South. We investigate the relationship between green space and health as well as its underlying mechanism in Cali, Colombia. Results indicate that neighbourhood greenness is associated with enhanced self-rated ‘good’ health and reduced physical and mental distress. The health benefits of green space appear to be stronger for people living in wealthier neighbourhoods than those in poor neighbourhoods. Results highlight the importance of considering health disparities for future green infrastructure planning in the global South context.


Frank, Lawrence D., Hong, A., and Ngo, V.D. (2019). Causal evaluation of urban greenway retrofit: A longitudinal study on physical activity and sedentary behavior. Preventive Medicine, 123, 109-116.

Studies of the built environment and physical activity (PA) have primarily been cross-sectional. Evidence on the causal impacts of transportation improvements on PA and sedentary behavior (SB) is lacking. This study assessed the effect of retrofitting an urban greenway on PA and SB in Vancouver, Canada. A sample of 524 participants (median age of 44; 57% female) were divided into experimental and control groups, and the effect of exposure to the greenway was examined by using different distance thresholds. Self-report measures of moderate-to-vigorous PA (MVPA) and SB were collected using the International Physical Activity Questionnaire (IPAQSF) before (baseline; 2012-2013) and after (follow-up; 2014-2015) construction of the ComoxHelmcken Greenway in 2013. Mixed-effects models estimated the impacts of greenway on MVPA and SB. For participants living near the greenway (≤ 300m), the odds of achieving an average of 20 minutes of daily MVPA doubled (OR=2.00; 95% CI=1.00, 3.98) after the greenway’s opening. The odds of being sedentary for more than 9 hours declined by 54% (OR=0.46; 95% CI=0.25, 0.85; p < 0.01) after opening. PA benefits from the greenway declined with distance from 100 meters to 500 meters. Reduction in SB was lowest at 100 meters and greatest at 300 meters. Retrofitting an urban residential neighborhood through greenway intervention can be successful in promoting physical activity while reducing sedentary behavior. Recommendations for future longitudinal research include the use of objective PA measures, studying different neighborhood contexts, collecting more representative samples, and minimizing attrition.


Canham, Sarah L., Walsh, Christine A., Sussman, Tamara, Humphries, Joe, Nixon, Lara, & Burns, Victoria F. (2021). Identifying shelter and housing models for older people experiencing homelessness. Journal of Aging and Environment, 1–22.

Limited research has identified the types of shelter/housing and supports for the growing population of older people experiencing homelessness (OPEH) and the extent to which existing models align with their needs. To redress this gap, we conducted an environmental scan and three World Café workshops to identify and characterize shelter/housing models for OPEH in Montreal, Calgary, and Vancouver (Canada). Fifty-two models were identified and categorized into six shelter/housing types based on the program length of stay and level of health and social supports provided onsite: (1) Emergency, transitional, or temporary shelter/housing with supports; (2) Independent housing with offsite community-based supports; (3) Supported independent housing with onsite, non-medical supports; (4) Permanent supportive housing with onsite medical support and/or specialized services; (5) Long-term care for individuals with complex health needs and; (6) Palliative care/hospice, offering end-of-life services. Models that met the unique needs of OPEH had coordinated supports, social and recreational programming, assistance with daily tasks, and had a person-centered, harm-reduction approach to care. This typology of shelter/housing models offers a basis from which local and regional governments can audit their existing shelter/housing options and determine where there may be gaps in supporting OPEH.


Canham, Sarah L., Custodio, Karen, Mauboules, Celine, Good, Chloe, & Bosma, Harvey (2019). Health and psychosocial needs of older adults who are experiencing homelessness following hospital discharge. The Gerontologist, 60(4), 715–724.

Though hospitals are a common location where older adults experiencing homelessness receive health care, an understanding of the types of supports needed upon hospital discharge is limited. We examined the unique characteristics of older homeless adults and the health and psychosocial supports required upon hospital discharge. Guided by principles of community-based participatory research (CBPR), we conducted 20 in-depth, semi-structured interviews with shelter/housing and health care providers in Metro Vancouver.


Hajjar, Ihab M., Keown, Michelle, Lewis, Paige, & Almor, Amit (2008). Angiotensin converting enzyme inhibitors and cognitive and functional decline in patients with alzheimer's disease: An observational study. American Journal of Alzheimer's Disease & Other Dementias, 23(1), 77–83.

We previously reported that angiotensin converting enzyme inhibitors (ACEIs) decrease the rate of cognitive decline in elderly patients with hypertension, but their impact on patients with Alzheimer's disease (AD) is not known. A total of 62 elderly patients with AD were enrolled, and 52 completed the study for 6 months. Mini-Mental Status Examination (MMSE), Clock Draw Test (CDT), working memory (Digit Ordering), Instrumental Activities of Daily Living (IADL) scale, and the Screen for Caregiver Burden (SCB) were collected at baseline, 3 months, and 6 months. AD patients receiving ACEI (N = 15) demonstrated a slower rate of decline in digit forward (P = .003) and IADL scale (P = .003) and an improved measure of caregiver burden (P = .04) but not MMSE (P =.15) or CDT (P =.9) compared with those not receiving ACEI after adjusting for other risk factors. This study suggests that use of ACEI in AD patients is associated with slower rate of AD progression. A randomized clinical trial is needed to confirm our finding.


Hajjar, Ihab, Keown, Michelle, & Frost, Brandy (2005). Antihypertensive agents for aging patients who are at risk for cognitive dysfunction. Current Hypertension Reports, 7(6), 466–473.

Observational and experimental data continue to accumulate about the impact of blood pressure (BP) and antihypertensive agents on cognitive function. Current evidence suggests that there is a U-shaped association between BP earlier in life and poor cognitive function and clinical dementia, including Alzheimer's disease. This association has been identified more consistently in longitudinal surveys due to the fact that BP declines when cognitive symptoms start. Lowering BP provides protection against this complication of high BP. This effect is present in the cognitively intact and in those with dementia. Antihypertensives that cross the blood brain barrier and affect the renin-angiotensin-aldosterone system (such as perindopril or losartan) or brain calcium metabolism (nitrendipine) provide additional protection beyond BP control against cognitive decline. These drugs may be preferred in such clinical situations.

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Greer, Valerie (2019). Shared Sites: Design for Intergenerational Aging. Washington University in St. Louis.

This publication documents the work of a graduate level architectural design studio conducted at Washington University in St. Louis in 2019 which examines aging and intergenerational design from a multi-disciplinary approach.

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Greer, Valerie (2021, August). Aging in Place during the COVID-19 Pandemic. Osher Network Institute Newsletter.

This article highlights the study, "From Sheltered in Place to Thriving in Place: Dimensions of Aging in the 'Right' Place during the Pandemic" to identify the environmental factors that have helped older adults age in place during the COVID-19 pandemic. 

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