DRAFT**
Good health can be described in many ways. Achieving and maintaining good health depends on a variety of factors stretching far beyond just the individual themselves. Using a multilevel model of health affords us the ability to take a closer look at the dynamic relationship between all the influences on a person’s health and examine what drives the health of a population (Galea, 2015).
The social ecological model of health is an example of a multilevel model of health. This model demonstrates the relationship between the individual, their social network and interpersonal relationships, the community to which they belong, and the physical, social and political environments (Kilanowski, 2017).
During my career, I have spent a great deal of time assisting seniors to recover from falls, prevent future falls or lose their independence as a result of falls. Each year falls directly cost the province of British Columbia $200 million. 30 percent of individuals over the age of 65 experience 1 fall per year and many individuals fall frequently. [insert fall stats] [insert LMH specific data about falls, ALC rates, LTC admissions. The Government of BC website (n.d) states “by 2031, close to 1.5 million British Columbians across the province will be over 65—almost a quarter of the province’s population.”
Let us take a closer look at how we can apply a social ecological framework to the issue of keeping our seniors physically active within the communities where they live, work and play in order to prevent falls and resulting loss of function and independence. As demonstrated in Figure 1, the social ecological model can help us understand that aiming activity programs at individuals alone will not result in increased physical activity and that we must create social and physical environments that enable people to be active (Bornstein & Davis, 2014).
Figure 1
[find reference]
Gharaveis (2020) describes the things that impact physical activity at the individual level as genetics, overall health, demographics and attitudes towards physical activity. Not surprisingly Boulton (2017) noted that poor health and a lack of previous physical activity history were barriers to physical activity.
Speaking to the interpersonal or social environment, Boulton et al. (2017) found that designating one person to greet and welcome participants to the activity dictated future participation. Often the friendships and relationships built at the exercise sessions became the reason people returned (Boulton et al., 2017).
The built environment appears to play the most significant impact on sustained physical activity in the elderly (Ottini et al., 2016). Gharaveis (2020) describes how the built environment impacts physical activity in the elderly and can increase or decrease participation in activity. Environments found to be appealing, safe and convenient all increased participation in activities such as walking (Gharaveis, 2020). Other considerations, such as security, supervision and space for the use of assistive devices were also highlighted by Gharaveis (2020). Although outdoor environments were cited to have additional impacts of improved mental health and more visually appealing, Gharaveis found that indoor environments were favored by the elderly population (2020). A study conducted by Ottini et al (2016) in Vancouver, BC found a connection between the built environment and the social environment emphasized by the placement of benches the built environment. This relatively small piece of the built environment not only increased physical activity by providing opportunity for rest or steadying, but also created an environment for social interaction (Ottini et al, 2016).
The aforementioned findings have implications for policy makers and city planners. Gharaveis (2020) notes the importance of educating society about how the built environment impacts physical activity in the elderly. They go on to describe imploring designers to consider the aspects of the built environment that promote physical activity in the design of new environments. Gallagher & Mallhi (2010) recommends partnerships at the local, regional and provincial government levels, and between businesses, the community, the health care system and seniors advocacy groups in order to achieve an Age-friendly British Columbia.
References:
Age-friendly BC - Province of British Columbia. (n.d.). Retrieved February 28, 2021, from
Bornstein, D.J. & Davis, W.J. (2014). The Transportation Profession’s Role in Improving Public
Health. ITE Journal, Vol. 84 (7), 18-24.
Boulton, E. R., Horne, M., & Todd, C. (2018). Multiple influences on participating in physical activity
in older age: Developing a social ecological approach. Health Expectations, 21(1), 239–248.
Gharaveis, A. (2020). A systematic framework for understanding environmental design
influences on physical activity in the elderly population: A review of literature. In Facilities
(Vol. 38, Issues 9–10, pp. 625–649). Emerald Group Publishing Ltd.
Kilanowski, J. F. (2017). Breadth of the Socio-Ecological Model. In Journal of Agromedicine (Vol.
22, Issue 4, pp. 295–297). Taylor and Francis Ltd.
Ottoni, C. A., Sims-Gould, J., Winters, M., Heijnen, M., & McKay, H. A. (2016). “Benches become like
porches”: Built and social environment influences on older adults’ experiences of mobility and
well-being. Social Science and Medicine, 169, 33–41.
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