Over a decade since the World Health Organization’s recommendation for ‘age-friendly cities’ , the built environment continues to pose major hazards (e.g. falls due to uneven terrain) to older adults , which contribute to reduced community participation. Characteristics of the outdoor environment — such as uneven and wet surfaces, hazards on pavements and kerbs — have been identified as risk factors for falls in middle-aged and older adults . Physical inactivity is also a major public health concern, with older adults being one of the most sedentary age groups , which heightens their risk of mortality, metabolic disease and obesity. Emerging evidence suggests that outdoor physical environments pose significant challenges across the adult lifespan, and may not be fit for purpose to support active and independent living into later life [5, 6].
Redesign of the built environment, informed by new knowledge of how older adults engage with their surroundings, is attracting growing attention as a means through which to improve health and wellbeing in old age . Worldwide, new urban design initiatives are emerging to transform public spaces, increase physical activity, participation, and social interaction, and reduce the growing burden of chronic diseases, in older adults. Notable recent developments include exercise parks fit for older people’s purpose [7, 8], smart home technology , dementia villages , and scoping of ‘walkable’ neighbourhood design features . Sales et al.  reported that short-term use of a novel exercise park improved physical function in older adults, and was associated with high rates of adherence and participation. However, safety aspects of purpose-built outdoor exercise areas — for example where there is limited control over climatic and environmental changes — require further consideration . Other groups have reported that the immediate physical environment surrounding an older person’s home, and opportunities to participate in exercise within a social setting, are most important to support physical activity participation .
Related to this, social connectedness is a major factor underpinning older adults’ community participation, and therefore, environments designed to encourage interaction with others may be most effective in supporting healthy, active ageing. Several studies have explored the concept of ‘active transport’ and evaluated the key features of ‘walkable’ and pedestrian-friendly neighbourhoods, as a potential route by which to encourage physical activity in older adults [11, 13, 14]. Street connectivity, mixed land use , ease of access to destinations and transport and shared routes for walking and cycling are critical factors to consider in urban planning in order to help increase pedestrian activity at concentrated areas (e.g. shopping centres) which are meaningful to, and frequently visited by, older people . As important as utilisation of those spaces is people’s sense of connectedness, identification and belonging to the community within which those spaces exist (i.e., their neighbourhood or community identity). Such community belonging — reflected in people’s sense of social identification as us Glaswegians or us East Enders, for example — enables access to a range of psychological resources (support, control, resilience, self-esteem, etc.) that have recognised benefits for health and well-being . Particularly relevant to the present context is the positive role that such identification plays in supporting mobility . Thus, finding an optimal balance in land mix, specifically urban infrastructure and green space (such as parks, gardens, woodlands and green trails), and community identification is critical. Overload of environmental stimulation, including neighbourhood retail destinations and high urban density, may negatively impact on psychological wellbeing and cognition in later life [18, 19].
Connecting with nature within and beyond our built environments, including green and blue spaces, can also play a major role in promoting healthy ageing , with reported mental health benefits for middle-aged and older adults [21–24]. Evidence suggests that people who live in the ‘greenest’ communities are at lowest risk of presenting with psychological distress, and tend to adopt more physically active lifestyles, allowing them to experience nearby nature . Novel strategies have been implemented to facilitate interaction with green spaces including community walking maps  and social walking groups , to discourage sedentary behaviour and help older adults reap the health benefits from these surroundings and social interactions. Having a greater abundance of parks, located within close proximity to older people’s homes may be one solution to increase physical activity . However, overcoming challenges in maintaining parks that are safe, accessible, clean, attractive and nuisance-free, may determine the extent to which public green spaces are utilised . For older adults with a cognitive impairment, such as dementia, sensory gardens may offer therapeutic effects on psychological wellbeing and behaviour, if well thought through and carefully designed . Similarly, blue spaces (e.g. lakes, oceans, coastal regions) may also contribute to therapeutic landscape experiences, which can promote wellbeing in older people . Participation in water-based activities such as surfing , or simply exposure to a visible blue space , have been shown to reduce psychological distress, specifically anxiety and depression, in middle-aged and older adults.
Whilst evidence suggests there are multiple factors that play a major role in ‘healthy and active ageing’, it is not clear which factors are considered most important by older people. The thoughts and personal experiences of older people are critical to inform the development of research agendas and projects that address the current and future needs of ageing populations. Without knowledge of older people’s priorities, concerning their interaction with everyday outdoor environments, it is unlikely that any solutions (exclusively designed by researchers) to enhance ‘ageing well’ would be effective or attract user engagement. Our aim was to identify the needs of older people in relation to ageing well in the environment by bringing together knowledge from different stakeholder and interdisciplinary perspectives.
To undertake this and wider research, the National Institute for Health Research (NIHR) recommends that patients and members of the public should be involved in identifying and prioritising topics, and in designing, monitoring and evaluating their outcomes . An active partnership with patients and publics, initiated at an early stage in the research process can provide researchers with critical insight of lived personal experiences (e.g. what it is like to be an older person), which are used to inform the development and implementation of health research that is more relevant to the end-user. Patient and Public Involvement (PPI) can therefore be highly beneficial in developing, clarifying and affirming the importance of meaningful research questions, prior to seeking research funding. In this paper we report on the impact that stakeholder engagement and PPI had on identifying the research priorities for an international consortium, whose objective is to develop cutting-edge solutions to enhance safe, green everyday environments for ageing well. Key stakeholders including members of the public were specifically involved in the ‘Identifying’, ‘Prioritising’ and ‘Design’ stages of the research process, as a means to help plan the consortiums’ future work. Creative engagement activities were implemented during the PPI process to facilitate communication of tacit knowledge and shared understanding. Our use of creative activities, over other forms of engagement activities (e.g. involvement in steering committees), overlook power and epistemic injustice, where the knowledge (and voices) of non-academics are typically underprivileged in such ‘co-production’ settings. Creative methods can assist in rebalancing this injustice by offering an ‘alternative’ mode of sharing and communicating that is familiar to all, yet uncommon in research settings, which typically use written and spoken ‘jargon filled’ words in ways that are often exclusive .