Lifecourse of Place: how environments throughout life can support healthy ageing

Providing new insights into the how the places we live and grow older can be best designed to support healthy ageing has emerged as an important research and policy priority. Many studies have looked to identify the barriers to health and effective functioning for older people, and into producing environments experienced in older age that support people to age well. However, we know much less about the aspects of environments experienced throughout life that might support the maintenance of healthy functioning in later life. Therefore, this interdisciplinary proposal draws together expertise from geography, psychology and landscape architecture to utilise novel longitudinal datasets to examine how place-based circumstances from childhood through the rest of life can enhance healthy ageing.

The study draws on a new framework labelled the "life course of place" which helps us to examine how places evolve over time and matter at different points in the lifecourse in predicting later life health outcomes. We will utilise two longitudinal datasets - the Lothian Birth Cohort 1936 (LBC1936) alongside a suite of small area historical environmental measures - which were collated as part of an earlier study. The combined datasets provide detailed information on a cohort of people born in 1936 (LBC1936) as well as the environmental circumstances in which the participants lived at various points during their lives. These data collection efforts resulted in a unique dataset that captured the lifetime environmental circumstances (including green space, air pollution and area-level deprivation) of a cohort of older people alongside detailed individual-level information, including high quality indicators of healthy ageing. A key novelty of our work will be to examine full lifetime exposures. The study utilises a set of robust indicators of healthy ageing available for LBC1936 participants, collected through brain imaging, cognitive testing and biomarkers of biological ageing (telomere length and epigenetic clock). These outcomes are rarely utilised in social scientific research.

The overarching research question therefore is to examine whether lifetime exposure to green space, air pollution and area-level deprivation affect indicators of healthy ageing (measures of cognitive ageing, brain health and biological ageing). In particular, we will examine whether there are (a) critical periods (childhood, early adulthood, adulthood and later adulthood) in which the three area-level characteristics are particularly important in explaining the later life outcomes, and/or (b) whether the environmental factors accumulate over the lifecourse to affect healthy ageing. Our analyses will consider whether the relationships differ by sex and socioeconomic circumstances.

By examining relationships over the full lifecourse, the research findings have the potential to make a significant contribution to our understanding of the dynamics of places and the implications for health trajectories in later life. The UK Government has identified meeting the needs of an ageing society as one of its 'Grand Challenges' and has committed to identifying innovative ways to ensure older citizens can continue to contribute to society through leading independent and fulfilled lives. One of the defined missions in the strategy is to "ensure that people can enjoy at least 5 extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest." Our research will improve our understanding of the role of place throughout life in supporting healthy ageing, and identify critical periods in which key environmental factors affect subsequent health trajectories and inequalities. Therefore, by identifying actionable, long-term and sustainable policy opportunities, and working with our key project partners, the proposed research has the potential to make significant contributions to meeting the needs of an ageing society.

We aim to increase recognition of the role of the environment across the life course in affecting cognitive and brain ageing, and evidence policy opportunities for enhancing the beneficial influences of the places in which we age. The impact goals of this study are to: (i) inform the development of future healthy ageing policies, particularly relating to environmental planning and management; (ii) influence the political and public discourse, reframing debates regarding place-based factors affecting healthy ageing; and (iii) build capacity in undertaking the complex analyses needed to fully understand the influence of environments over the life course on health.

The key, long-term beneficiaries of our research will be older people, their families and carers. We have identified three sets of stakeholders with whom we will work with closely to accelerate the impact of our research: (i) older people's advocacy organisations; (ii) policymakers working to enable older people to live healthy, active and independent lives; and (iii) wider public including older people. Our proposal has been developed in collaboration with key partners representing the key stakeholder groups: Age UK (advocacy), NHS Health Scotland (policy), and the Place Standard Team at Scottish Government (policy). These ambitions will be supported by a series of activities working with each of the three sets of stakeholders. The nature of the activities will reflect the needs and interests of the target audiences and utilise seminars, workshops, debates, interactive websites, and conference presentations as appropriate.

First, our key partner advocating for older people's concerns will be Age UK. We have costed for a series of events that build on our well-established track record of collaboration between the research team and Age UK. The key outcomes will be: a co-produced workshop with older people, older people's organisations, social care, and healthcare practitioners; a plain language research summary targeting a general audience of typically older people and their families; other co-produced research summaries (e.g. for The Geographer, a Royal Scottish Geographical Society publication with an international readership of >12,000); and supplementing online resource currently being developed for older people which summarises the relevant scientific evidence.

Second, our key partners working in the policy arena will be NHS Health Scotland and the Scottish Government. In particular, we will work with the Place Standard team led by NHS Health Scotland (see: www.placestandard.scot/) to develop: a workshop for practitioners in environmental planning, design and management, and in service delivery who use (or wish to use) the tool; a policy brief, specifically targeted at policy makers; and a senior-level invitation only KE workshop to engage policymakers with our study, as the findings emerge, and consider their implications for policy development. We will also continue our ongoing engagement with Cross-Party Groups, public committees, networking events and consultations (e.g. offering contributions to the meetings of the Scottish Parliament's Cross Party Groups on Health Inequalities and/or Older People and Ageing).
Finally, we will engage with a broad public audience through online content. This will include the policy paper and summaries prepared for expert and lay audiences and through publishing on our research group webpages which are important vehicles for disseminating research findings (e.g. blog posts and our social media channels). We will support public participation in local decision by making our results and data publically available via our mapping and data sharing web tool https://creshmap.com We will organise a dedicated events such as the 2021 Edinburgh International Science Festival and take advantage of the regular end-of-wave LBC1936 Reunion Event organised for all study participants to discuss new findings from the proposed research.