Key age-friendly components of municipalities that foster social participation of aging Canadians: results from the Canadian Longitudinal Study on Aging

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Although making municipalities age-friendly is recognized as a promising way to help aging adults stay involved in their communities, little is known about the key components (e.g., services and structures) that foster social participation. This study thus aimed to identify key age-friendly components (AFC) best associated with the social participation of older Canadians. Secondary analyses were carried out using baseline data from the Canadian Longitudinal Study on Aging ( n =25,411) in selected municipalities ( m =110 with ≥30 respondents), the Age-friendly Survey, and census data. Social participation was estimated based on the number of community activities outside the home per month. AFC included housing, transportation, outdoor spaces and buildings, safety, recreation, workforce participation, information, respect, health and community services. Multilevel models were used to examine the association between individual social participation, key AFC, and environmental characteristics, while controlling for individual characteristics. Aged between 45 and 89, half of the participants were women who were engaged in 20.2±12.5 activities per month. About 2.5% of the variance in social participation was attributable to municipalities. Better outdoor spaces and buildings (p<0.001), worse communication and information (p<0.01), and lower material deprivation (p<0.001), were associated with higher social participation. Age was the only individual-level variable to have a significant random effect, indicating that municipal contexts may mediate its impact with social participation. This study provides insights to help facilitate social participation and promote age-friendliness, by maintaining safe indoor and outdoor mobility, and informing older adults of available activities. CLSA Community Community-dwelling Canada Deprivation Recreation Communication Local policy Urban policy Introduction World population aging creates new challenges for health and well-being, and calls for a shift towards promoting active aging and equitable access to social care[ 1 ]. By 2038, 23% of Canadians are expected to be 65 and over, even exceeding one third in the Atlantic provinces[ 2 ]. This warrants the need for adapted, effective and innovative interventions to maintain and improve health, equity and well-being, particularly by promoting social participation. Social participation is defined as a person’s involvement in activities providing interactions with others[ 3 ] in community life and in important shared spaces. It evolves according to available time and resources, the societal context and what individuals want and is meaningful to them[ 4 ]. Social participation of older adults is influenced by multiple individual characteristics, such as age, gender[ 5 ], functional capacities[ 6 ], socioeconomic status[ 7 ], and having a driver’s license[ 6 ]. Higher social participation has also been found to be associated with several health outcomes such as lower risk of premature mortality[ 8 ], greater self-rated overall health[ 9 ], and better functional autonomy[ 10 ]. Social participation can be fostered by municipalities through age-friendly policies, services and structures related to the communities’ material and social environments, which optimize the interactions between the abilities of the person and their environment. In fact, supporting older adults in staying active by enabling social participation and inclusion in community life is an essential component of public policies promoted by the World Health Organization (WHO)[ 11 ]. In Canada, municipalities from all provinces and territories recognize the need for supportive environments 13 according to an age-friendly approach[ 12 ]. Although increasing the age-friendliness of municipalities is important, little is known about which characteristics of a municipality best foster social participation. According to a Chinese study of 1,383 aging adults (≥ 60 years old), clean and safe outdoor spaces, effective and helpful communication, and diverse and accessible community and health services were associated with more social support and activities[ 13 ]. In a smaller study of 171 older adults living in four Canadian cities (Ottawa, Thunder Bay, Toronto, and Victoria), greater age-friendliness was correlated with enhanced social participation and greater satisfaction with social relationships and support[ 14 ]. More specifically, safety and information and advocacy were associated with the latter. Canadians municipalities where aging adults (≥ 45 years old) report greater positive health, social participation and health equity had higher population, dwelling and intersection density averages, and residents felt safer, more included and supported, than in the other municipalities[ 15 ]. According to another Canadian study, the user-friendliness of the walking environment and proximity to key resources (e.g.: groceries, banks, pharmacies or community centers) was correlated with a higher frequency of social activities but was moderated by disability in older men (74.5 ± 4.0 years old)[ 10 ]. Semi-structured focus groups were also conducted with older adults, professionals and local actors from two Quebec municipalities (Saint-Bruno-de-Montarville and Sainte-Julie) where older residents age more actively[ 16 ]. According to the focus groups, age-friendliness promotes active aging by favoring proximity and human-scale environments, as well as transversality ( e.g. , opportunities for intergenerational interactions in accessible public spaces)[ 16 ]. Since older adults with restricted mobility reported lower satisfaction with social participation[ 17 ] universal accessibility may also be important. In addition to age-friendly components, other neighbourhood characteristics were found to be associated with higher social participation of older adults, such as the urban and rural classification, street connectivity, population density, and affluence[ 18 ]. Moreover, a greater proportion of older residents was correlated with higher age-friendliness in Manitoban rural municipalities, especially in the domains of social environment, opportunities for participation, and communication and information[ 19 ]. Despite these studies, age-friendly key components that best foster social participation of aging adults remain mostly undetermined. A better understanding of the components of Canadian municipalities that are most associated with individual social participation is essential to support health professionals and local actors in crafting holistic interventions that enhance the social participation of aging adults living in the community. This study thus aimed to identify key age-friendly components of municipalities that best promote the social participation of older Canadians. Method Design and participants Secondary data analyses were carried out using: 1) the Canadian Longitudinal Study on Aging (CLSA), a nationwide cohort study on adults living in private dwellings and aged 45–85 at baseline (2012–2015)[ 20 ] which collected individual health, sociodemographic and neighbourhood data, 2) the Canadian census (2016)[ 21 ], for which all municipal demographic and income data were released, and 3) The Canada-wide Age-Friendly Survey (AFS)documenting key age-friendly components of municipalities (2017)[ 22 ]. For the study’s objective, individual and municipal data had to be considered. The individual data were based on the CLSA’s respondents recruited in two cohorts, using a stratified random sampling strategy based on age, gender and province. Potential respondents were excluded if they could not communicate in English or French, lived in one of the three Canadian territories, were full-time members of the Canadian Armed Forces or lived on First Nations reserves or settlements. A comprehensive cohort ( n = 30,111) was recruited among aging adults living within 25 km of a data collection site (or within 50 km in lower-density cities). A tracking cohort ( n = 21,241) recruited respondents from the ten provinces. In the present study, both cohorts were considered and respondents ( n = 41,400) were included if they lived in municipalities ( m = 170) that had at least 30 CLSA participants, a group size found sufficient to produce reliable coefficient estimates for linear multilevel models[ 23 ]. For the municipal data , the 2016 Canadian census was used to gather data about municipal demographic characteristics[ 21 ], specifically a) the material and social deprivation indices, as compiled by the National Institute of Public Health of Quebec[ 24 ], b) the urban/rural typology and c) demographic data. Moreover, the AFS questionnaire, documenting the key age-friendly components, was sent to all Canadian municipalities ( M = 3,555)[ 25 ]; and was completed by the mayor or a person appointed by the mayor. A total of 921 municipalities (27.0%) completed the AFS questionnaire, mostly from Quebec, the Prairie provinces (Alberta, Saskatchewan and Manitoba) and Ontario. For the current study, the available sample comprises a total of 25,411 respondents living in 110 municipalities that completed the AFS, with at least 30 CLSA participants. The Research Ethics Committee of the Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke, approves this secondary analysis of the CLSA data (MP-31-2017-656). Individual variables From the CLSA, the dependent variable, social participation, reports the frequency of participating in eight activities outside the home with others: family or friends outside the household, church or religious, sports or physical, educational and cultural, service club or fraternal organization, neighbourhood, community or professional association, volunteer or charity work, and other recreational activities. Responses are converted into the number of social activities monthly: “at least one a day” = 20; “at least one a week” = 6; “at least one a month” = 2; “at least one a year” = 1; and “never” = 0[ 26 ]. The number of monthly activities for each category is summed (theoretical range = 0–160; observed range = 0–146) and a higher score represents a higher frequency of participation. The instrument has good internal consistency (α = 0.85)[ 6 ]. Five continuous variables from the CLSA were used to describe and compare characteristics of respondents: age, household size (excluding self), number of chronic conditions, depressive symptoms score (10-item Center for Epidemiologic Studies Depression scale [CES-D-10])[ 27 ], and social support score (Medical Outcomes Study [MOS] Social Support Survey)[ 28 ]. The CES-D-10 is a widely used instrument that estimates the weekly frequency of 10 items associated with depressive symptoms (e.g., being bothered, feeling fearful) and has shown good internal consistency (α = 0.72)[ 29 ]. The MOS Social Support Survey includes 19 items evaluating emotional, informational, tangible and affectionate support, and positive social interaction and presented good reliability (α = 0.78) and a minimal detectable change of 1.57 among older adults[ 28 ]. Thirteen other categorical variables from the CLSA were also considered: gender, immigration status, education level, marital status, household income class, retirement status, dwelling ownership, driver’s licence possession and use, absence of pain and discomfort and having had at least one fall in the last year, and functional limitations (basic and instrumental activities of daily living [ADL and IADL]). Both ADL and IADL measures were dichotomized (some limitations/no limitations) according to whether participants could perform all activities unassisted. Municipal variables All municipal data were measured or aggregated within municipal boundaries, which facilitated the merging with the CLSA data. From the 2016 Canadian census , the material deprivation index considers the proportion of persons without a high school diploma and employed, as well as the average personal income. The social deprivation index is based on the proportion of persons living alone, separated, divorced or widowed, and single-parent families[ 30 ]. Measured at the scale of the dissemination area (DA; a sub-municipal statistical unit embedded within the municipality’s boundaries) and grouped by quintiles, higher categories are associated with enhanced deprivation. Because the deprivation index was only available at the DA level, it was rescaled at the municipality level through a weighted average of the quintile of each DA encompassed by a municipality[ 25 ]. Based on Statistics Canada’s typology[ 31 ], municipalities were classified as urban or rural. The former includes adjacent municipalities centered on a city core, within census metropolitan areas (CMAs; ≥100,000 inhabitants) and census agglomerations (CAs; ≥50,000), and non-adjacent municipalities (≥ 10,000, known as fringe areas). The latter (rural) refers to non-urban areas within and outside CMAs and CAs. Finally, demographic data (all measured at the municipal level) included total population density (inhabitants/km 2 ) and the percentage of the population aged 65 and over, within the municipality’s boundaries. The Age-Friendly Survey (AFS) is adapted[ 25 ] from the original survey designed by Menec and colleagues[ 19 ]. The AFS contains 56 items for which municipal age-friendliness is coded as: 1) yes, 2) no or 3) I don’t know. The items are categorized within nine key components (Appendix 1). Items answered yes were summed for each component, then standardized on a 0-100 scale for comparison, higher scores representing greater age-friendliness. Analysis Participants and municipalities were described using means and standard errors for continuous variables, or frequencies and percentages for categorical ones. 33 Multilevel models were used to identify key age-friendly components (level-2) of municipalities best associated with individual social participation (level-1). First, a null model calculated the intra-class correlation and proportion of the total variation explained at the municipal level. Second, individual covariables (age, sex and functional limitations in activities of daily living) were added and tested for fixed and random effects of their relationship with social participation. Third, the nine key age-friendly components were added. Fourth, interactions were tested between significant variables of the two levels. Lastly, other municipal variables were added (material and social deprivation indices, urban/rural classification, total population density and the percentage of the population aged 65 and over). At all steps, a backward elimination strategy with a p -value < 0.05 was used to select the variables. In addition, as recommended, the CLSA Sample Weights[ 32 ] version 1.2 were applied for all analyses, which were carried out using HLM 8[ 33 ]. Results Individual characteristics The available sample comprises a total of 25,411 respondents living in 110 municipalities that completed the AFS. Aged between 45 and 89 years, most respondents engaged monthly in an average of 20 social activities with others and lived with at least another person (Table 1 ). Respondents also reported an average of three chronic conditions, few depressive symptoms and good social support. Equally distributed according to sex, most respondents had a post-secondary education and household income below 100,000 CAD, were living in a couple, were free of discomfort, were owners of their dwelling, had a driver’s license and used it, and could accomplish their ADL. Almost one respondent out of five was born outside of Canada, a third were retired and one in ten had fallen during the previous year (Table 1 ). When compared to the total CLSA sample ( n = 51,352), those in the present study had had one less activity per month on average (p < 0.001; data not shown) and fewer chronic conditions (p < 0.001). Respondents in the current study were also statistically less likely to be female (p < 0.001), be born outside Canada (p < 0.001), have a post-secondary education (p < 0.001) or a household income above 50K CAD (p < 0.001), live in a couple (p < 0.001), feel pain or discomfort (p < 0.001), and not drive a car (p < 0.001). Table 1 Description of respondents (n = 25,411) Continuous variables Total n missing Mean (SE) Social participation (# activities / month) 20.2 (0.1) 0 Age (years) 59.9 (0.1) 0 Number of chronic conditions 3.3 (0.0) 30 Depressive symptoms (CES-D-10 score) a 5.4 (0.0) 125 Household size (including respondent) 2.5 (0.0) 26 MOS Social support score b 81.8 (0.1) 207 Categorical variables Total n (%) n missing Female (vs. male) 12,981 (50.1) 0 Immigrant (vs. born in Canada) 4,489 (17.1) 4 Post-secondary education (vs. no post-secondary) 20,821 (83.6) 59 In a couple (vs. alone) 16,800 (73.4) 8 Household income 1,149 < 20K CAD 3,997 (15.1) 20K – <50K CAD 9,412 (33.7) 50K – <100K CAD 7,746 (32.4) 100K – 150K CAD 1,142 (5.5) Fully or partly retired (vs. not retired) 14,186 (44.6) 95 Homeowner (vs. non-homeowner) 21,164 (85.3) 40 Has a driver’s license 22,251 (88.9) 1,471 Drives a motor vehicle (primary transportation) 17,608 (71.0) 3,451 Absence of pain or discomfort (vs. pain) 14,617 (58.9) 1,485 Fell last year (vs. did not fall) 2,735 (10.4) 1,469 Activities of daily living (ADL) 24,644 (97.5) 3 Instrumental activities of daily living (IADL) 23,809 (94.9) 4 SE: standard error; unweighted n and weighted %. a 10 items answered on a 4-level scale (0 = rarely or never; 3 = all of the time), then summed (0 to 30), with higher scores indicating greater depressive symptoms[ 27 ]. b 19 items answered on 5-level scale (1 = none of the time; 5 = all of the time), then summed (0–100), with higher scores indicating more support[ 28 ]. Municipal characteristics Municipalities that had at least 30 CLSA respondents but did not complete the AFS questionnaire ( m = 60) did not differ from those that did (data not presented). Municipalities were mainly urban with a density less than 1,000 inhabitants per km2, about a fifth of their total population was aged 65 and older and their material and social deprivation were above the Canadian median, indicating greater deprivation (Table 2 ). Most municipalities reported high levels of age-friendliness overall but varied according to the key components: Respect and social inclusion, Outdoor spaces and buildings, as well as Community and workforce participation (which includes opportunities for volunteering). Municipalities reported lower age-friendliness for Communication and information adapted for an older population and adapted and affordable Housing. Table 2 Description of municipalities (m = 110) Continuous variables Total Mean (SE) Density (persons/km 2 ) 887.8 (93.5) Population aged 65+ (%) 18.8 (0.5) Material deprivation index (weighted average) 2.7 (0.1) Social deprivation index (weighted average) 2.8 (0.1) Key age-friendly components score Outdoor spaces and buildings 75.8 (21.9) Safety 68.5 (32.2) Social participation 72.6 (22.2) Community and workforce participation 74.1 (26.6) Communication and information 58.2 (23.1) Respect and social inclusion 82.0 (25.4) Housing 58.0 (30.3) Transportation 69.7 (24.2) Community support and health services 61.9 (22.0) Categorical variables n (%) Urban (vs. rural) 81 (73.6) AFC: Age-friendly components; SE: standard error According to the null model, 2.5% of the social participation variance was explained at the municipal level, regardless of their characteristics or key age-friendly components (data not shown). Accounting for individual and municipal characteristics, the final model is presented in Table 3 . Regarding the individual-level variables, higher social participation was associated with older age, being female, having a post-secondary education, living alone, having fewer chronic conditions and depressive symptoms, being retired, having a higher household size, more social support, a driver’s license, and no functional limitations. The only random slope was for the relationship between social participation and age, which indicates that this relationship varies across municipalities. Municipal variables had a significant effect on the intercept, with the final model showing that higher social participation was associated with lower material deprivation, higher age-friendliness of Outdoor spaces and buildings, and lower Communication and information (Table 3 ). No interaction was found between age and key AFC, which means that the varying relationship between age and social participation across municipalities could not be explained by age-friendly components. Table 3 Final model from multilevel regression for the social participation of aging adults in Canadian municipalities (n respondents = 25,411; n municipalities = 110) Fixed effect Coef. SE t-ratio p-value Intercept 12.47 0.78 15.93 < 0.001 Municipal characteristics (level-2) Material deprivation index -0.93 0.23 -4.05 < 0.001 Key age-friendly components Outdoor spaces and buildings 0.03 0.01 3.41 < 0.001 Communication and information -0.02 0.01 -3.10 < 0.01 Individual characteristics (level-1) Age (years) 0.13 0.02 7.80 < 0.001 Female (vs. male) 1.75 0.18 9.82 < 0.001 Post-secondary education (vs. no post-secondary education) 2.54 0.24 10.78 < 0.001 In a couple (vs. alone) -0.73 0.24 -3.01 < 0.01 Number of chronic conditions -0.09 0.04 -2.24 0.03 Depressive symptoms (CES-D-10) -0.21 0.03 -7.35 < 0.001 Fell last year (vs. did not fall) 0.67 0.30 2.21 < 0.05 Fully or partly retired (vs. not retired) 1.39 0.27 5.13 < 0.001 Household size 0.35 0.13 2.65 < 0.01 MOS social support 0.12 0.01 16.37 < 0.001 Has a driver’s licence 1.69 0.56 3.04 < 0.01 No limitation in activities of daily living 1.10 0.55 2.00 0.05 No limitation in instrumental activities of daily living 1.94 0.38 5.09 < 0.001 Random effect Variance component df χ 2 p-value Level 1 effect, r ij 131.57 Intercept (social participation mean), u 0j 1.85 106 345.79 < 0.001 Age slope, u 1j 0.01 109 182.60 < 0.001 Coef: coefficient; SE: standard error; df: degrees of freedom Discussion This study aimed to identify key age-friendly components best associated with the social participation of older Canadians. Although social participation has been essentially explained by individual factors, the present multilevel study showed that higher social participation at the individual-level was associated with two key age-friendly components of municipalities, Outdoor spaces and buildings and Communication and information, as well as lower material deprivation. In addition, material deprivation was the only other municipal characteristic also associated with the social participation of aging adults. The relationship between age and social participation was also different across municipalities. In line with other studies[ 13 , 34 ], age-friendly outdoor spaces and buildings facilitated the social participation of aging Canadians. Well-maintained, outdoor and walking environments enable older adults to move around in their community in a safe manner. For example, timely snow clearing was the most reported item from the outdoor spaces and buildings component[ 25 ], an essential factor for mobility during Canadian winters. Similarly, an age-friendly environment ( e.g. , accessible public restrooms, buildings and stores and active transportation infrastructures) has been found by other studies to be a known social participation facilitator[ 34 ], which increases the likelihood that a person will go outside and enjoy their getting to their activity and participating. Contrary to previous studies, which highlighted its importance for active aging[ 14 ], this study reported that a less age-friendly Communication and information component was associated with slightly higher social participation. Although this result should be further investigated, this association might be explained by the fact that informal networks compensated for and enhanced social participation in the absence of official documentation in languages other than French and English, or services aimed at helping them complete official forms. Additionally, Communication and information was a key age-friendly component within the lowest average scores, possibly because providing elder advocacy services and documentation in non-official languages may only be applicable to larger municipalities with a greater share of immigrants, where smaller municipalities may be less age-friendly, but still facilitate social participation. The importance of a digital divide and informal network of communication should also be further investigated. Recent research with older adults and local actors in the Eastern Townships, Quebec, Canada[ 35 ] showed how communities rely on on newsletters, directories, resource booklets and door-to-door outreach to increase awareness of available activities and promote social participation and health equity. Exploring the individual items in the Communication and information component could be insightful. The study confirms the association between social participation and material deprivation, suggesting that thriving and wealthier communities would have policies and resources in place to facilitate mobility and opportunities for social activities[ 18 ]. A British longitudinal study found that materially-deprived neighborhoods have limited a wide range of social activities for older adults, including civic and leisure participation, as well as activities with family and friends[ 36 ]. The authors also found that the participation of aging adults decreased at a faster rate in more-deprived versus more-affluent neighborhoods, making them vulnerable to social isolation. Nonetheless, reducing material deprivation of municipalities with aging populations can foster social participation, notably by providing the older population with more opportunities for social interactions and options for adapted housing. Age was the only individual-level variable to have a significant random effect, indicating that municipal contexts may mediate the impact on the association between social participation and age. Although previous research showed that age is a significant predictor of social participation[ 8 ], the present results reveal that municipal characteristics not included in the models may facilitate or impede how older Canadians of various ages engage in social activities. For example, mixed-use zoning could facilitate getting outside of one’s home to accomplish activities of daily living and (spontaneously or intentionally) meeting with other people, which could be relevant when mobility is restricted. In addition to using the AFS to assess the municipal age-friendly components, a qualitative assessment of the neighborhood may explain how municipal contexts interact with age to foster or impede social participation, while taking into account the heterogeneity of aging populations[ 16 ]. Strengths and limitations To our knowledge, this study is the first to use extensive data nested in municipalities to explain social participation. The large sample size of participants and municipalities, applied with the weighting matrix, enabled population-level inferences. This study also has some limitations. Discarding municipalities with fewer than 30 respondents for the purpose of multilevel modelling, resulted in excluding most rural areas, limiting generalization to all municipalities. Initially calculated at the DA level, material deprivation was rescaled using weighted averages at the larger municipal level, similar to other works[ 25 ], which reduced the variability of deprivation (F = 0.395l; p < 0.001) and possibly prevented observing a stronger effect. Lastly, municipalities might be too large to model the association between social participation and the environment. Although representing a diversity of neighbourhoods, some key components may nevertheless be attributable to the larger regional scale ( e.g. , transportation). Conclusion Using population-based representative data and multilevel regression modelling, this study aimed to identify key age-friendly components of Canadian municipalities best associated with social participation of aging adults. Considering other individual and municipal variables, higher age-friendliness of outdoor spaces and buildings, and lower communication and information were associated with higher social participation. Additionally, the study confirmed the association of material deprivation with lower social participation of aging adults. Although social participation was primarily explained by individual factors, a multilevel approach exploring the municipal context provides grounds for testing theories and designing policies and interventions that could change behaviors and attitudes associated with age-friendly components. Because correlates of social participation may differ according to the types of activities respondents engaged in, future studies should consider analyzing finer spatial units, in addition to the profiles of social participation, rather than the total monthly participation. Overall, this study provides valuable insights to facilitate social participation and promote age-friendliness, by maintaining safe indoor and outdoor environments, and inclusively informing older adults of activities that are available. Declarations Funding Statement: This study was supported by a Foundation Grant (#148466) from the Canadian Institutes for Health Research. Mélanie Levasseur is a Fonds de recherche du Québec Santé (FRQS) Senior Researcher (#298996) and a Canadian Institutes of Health Research (CIHR) New Investigator (#360880). Parminder Raina holds the Raymond and Margaret Labarge Chair in Optimal Aging and Knowledge Application for Optimal Aging, is the Director of the McMaster Institute for Research on Aging and the Labarge Centre for Mobility in Aging and holds a Tier 1 Canada Research Chair in Geroscience. Acknowledgments: This research was made possible using the data/biospecimens collected by the Canadian Longitudinal Study on Aging (CLSA). Funding for the Canadian Longitudinal Study on Aging (CLSA) is provided by the Government of Canada through the Canadian Institutes of Health Research (CIHR) under grant reference: LSA 94473 and the Canada Foundation for Innovation, as well as the following provinces, Newfoundland, Nova Scotia, Quebec, Ontario, Manitoba, Alberta, and British Columbia. This research has been conducted using the CLSA Baseline Data Version 3.4 (tracking cohort) and 4.1 (comprehensive cohort), under Application Number 170314. The CLSA is led by Drs. Parminder Raina, Christina Wolfson and Susan Kirkland. Material and Social Deprivation Indices (MSDI), indexed to DMTI Spatial Inc. postal codes, were provided by CANUE (Canadian Urban Environmental Health Research Consortium). Material and Social Deprivation Indices (MSDI) used by CANUE were provided by the Institut national de santé publique du Québec (INSPQ). Indices were compiled for 1991, 1996, 2001 and 2011 Census data by the Bureau d’information et d’études en santé des populations [https://www.inspq.qc.ca/en/expertise/information-management-andanalysis/deprivation-index]. Please refer to the Material and Social Deprivation Indices dataset documentation available under the Data section of the CANUE website (www.canue.ca) for additional information. Disclaimer : The opinions expressed in this manuscript are the authors’ own and do not reflect the views of the Canadian Longitudinal Study on Aging. Data Availability Statement : Data are available from the Canadian Longitudinal Study on Aging (www.clsa-elcv.ca) for researchers who meet the criteria for access to de-identified CLSA data. References Statistics Canada. Table 17-10-0057-01 - Projected Population, by Projection Scenario, Age and Sex, as of July 1 . Ottawa, ON: Government of Canada, 2022. Statistics Canada. 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BMC Public Health 2017; 17 :502. Maas CJ, Hox JJ. Sufficient sample sizes for multilevel modeling. Methodology 2005; 1 :86–92. Institut national de santé publique du Québec [National Institute of Public Health of Quebec]. Material and Social Deprivation Index. INSPQ Centre d'expertise et de référence en santé publique 2019. St-Pierre C, Braverman L, Dubois M-F et al. Convivialité des municipalités canadiennes à l’égard des aînés: portrait et facteurs associés. Can J Public Health 2022:579–88. Richard L, Gauvin L, Kestens Y et al. Neighborhood resources and social participation among older adults: results from the VoisiNuage study. J Aging Health 2013; 25 :296–318. Andresen EM, Malmgren JA, Carter WB et al. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med 1994; 10 :77–84. Robitaille A, Orpana H, McIntosh CN. Psychometric properties, factorial structure, and measurement invariance of the English and French versions of the Medical Outcomes Study social support scale. Health Rep 2011; 22 :1–8. Mohebbi M, Nguyen V, McNeil JJ et al. Psychometric properties of a short form of the Center for Epidemiologic Studies Depression (CES-D-10) scale for screening depressive symptoms in healthy community dwelling older adults. Gen Hosp Psychiatry 2018; 51 :118–25. Pampalon R, Hamel D, Gamache P et al. An area-based material and social deprivation index for public health in Québec and Canada. Can J Public Health Rev Can Sante Publique 2012; 103 :S17-22. Statistics Canada. Core, Fringe and Rural Area . Ottawa, Ontario: Statistics Canada, 2018. Raina P, Wolfson C, Kirkland S et al. Cohort Profile: The Canadian Longitudinal Study on Aging (CLSA). Int J Epidemiol 2019; 48 :1752–1753j. Raudenbush SW, Congdon RT. HLM 8: Hierarchical linear and nonlinear modeling. 2021. Townsend BG, Chen JT-H, Wuthrich VM. Barriers and Facilitators to Social Participation in Older Adults: A Systematic Literature Review. Clin Gerontol 2021; 44 :359–80. Maclure M, Bouffard A, Morin M-K et al. Importance de la nature, des opportunités d’activités, de leur accessibilité et de leur publicisation pour favoriser la santé positive, la participation sociale et l’équité en santé d’Estriens âgés. Submitted . Prattley J, Buffel T, Marshall A et al. Area effects on the level and development of social exclusion in later life. Soc Sci Med 2020; 246 :1–11. Cite Share Download PDF Status: Published Journal Publication published 18 Aug, 2023 Read the published version in Journal of Urban Health → Version 1 posted Editorial decision: Accept as is 22 Jun, 2023 Reviewers agreed at journal 05 Jun, 2023 Reviewers invited by journal 02 Jun, 2023 Editor assigned by journal 14 Apr, 2023 First submitted to journal 12 Apr, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2809278","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":191949815,"identity":"5f59ad2d-0cef-46f2-8a25-2ca22cb96c5c","order_by":0,"name":"Mélanie 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Impact","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Parminder","middleName":"","lastName":"Raina","suffix":""}],"badges":[],"createdAt":"2023-04-12 19:57:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2809278/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2809278/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11524-023-00762-7","type":"published","date":"2023-08-18T22:01:19+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":44737028,"identity":"d430a069-2fdc-46d1-8590-80aec8f17bbb","added_by":"auto","created_at":"2023-10-16 22:32:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":742515,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2809278/v1/985df695-8090-465a-b8f9-67cc657239f4.pdf"}],"financialInterests":"","formattedTitle":"Key age-friendly components of municipalities that foster social participation of aging Canadians: results from the Canadian Longitudinal Study on Aging","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWorld population aging creates new challenges for health and well-being, and calls for a shift towards promoting active aging and equitable access to social care[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. By 2038, 23% of Canadians are expected to be 65 and over, even exceeding one third in the Atlantic provinces[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This warrants the need for adapted, effective and innovative interventions to maintain and improve health, equity and well-being, particularly by promoting social participation. Social participation is defined as a person\u0026rsquo;s involvement in activities providing interactions with others[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] in community life and in important shared spaces. It evolves according to available time and resources, the societal context and what individuals want and is meaningful to them[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Social participation of older adults is influenced by multiple individual characteristics, such as age, gender[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], functional capacities[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], socioeconomic status[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and having a driver\u0026rsquo;s license[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Higher social participation has also been found to be associated with several health outcomes such as lower risk of premature mortality[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], greater self-rated overall health[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and better functional autonomy[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSocial participation can be fostered by municipalities through age-friendly policies, services and structures related to the communities\u0026rsquo; material and social environments, which optimize the interactions between the abilities of the person and their environment. In fact, supporting older adults in staying active by enabling social participation and inclusion in community life is an essential component of public policies promoted by the World Health Organization (WHO)[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In Canada, municipalities from all provinces and territories recognize the need for supportive environments\u003csup\u003e13\u003c/sup\u003e according to an age-friendly approach[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough increasing the age-friendliness of municipalities is important, little is known about which characteristics of a municipality best foster social participation. According to a Chinese study of 1,383 aging adults (\u0026ge;\u0026thinsp;60 years old), clean and safe outdoor spaces, effective and helpful communication, and diverse and accessible community and health services were associated with more social support and activities[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In a smaller study of 171 older adults living in four Canadian cities (Ottawa, Thunder Bay, Toronto, and Victoria), greater age-friendliness was correlated with enhanced social participation and greater satisfaction with social relationships and support[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. More specifically, safety and information and advocacy were associated with the latter. Canadians municipalities where aging adults (\u0026ge;\u0026thinsp;45 years old) report greater positive health, social participation and health equity had higher population, dwelling and intersection density averages, and residents felt safer, more included and supported, than in the other municipalities[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. According to another Canadian study, the user-friendliness of the walking environment and proximity to key resources (e.g.: groceries, banks, pharmacies or community centers) was correlated with a higher frequency of social activities but was moderated by disability in older men (74.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0 years old)[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Semi-structured focus groups were also conducted with older adults, professionals and local actors from two Quebec municipalities (Saint-Bruno-de-Montarville and Sainte-Julie) where older residents age more actively[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. According to the focus groups, age-friendliness promotes active aging by favoring proximity and human-scale environments, as well as transversality (\u003cem\u003ee.g.\u003c/em\u003e, opportunities for intergenerational interactions in accessible public spaces)[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Since older adults with restricted mobility reported lower satisfaction with social participation[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] universal accessibility may also be important.\u003c/p\u003e \u003cp\u003eIn addition to age-friendly components, other neighbourhood characteristics were found to be associated with higher social participation of older adults, such as the urban and rural classification, street connectivity, population density, and affluence[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Moreover, a greater proportion of older residents was correlated with higher age-friendliness in Manitoban rural municipalities, especially in the domains of social environment, opportunities for participation, and communication and information[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these studies, age-friendly key components that best foster social participation of aging adults remain mostly undetermined. A better understanding of the components of Canadian municipalities that are most associated with individual social participation is essential to support health professionals and local actors in crafting holistic interventions that enhance the social participation of aging adults living in the community. This study thus aimed to identify key age-friendly components of municipalities that best promote the social participation of older Canadians.\u003c/p\u003e"},{"header":"Method ","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and participants\u003c/h2\u003e \u003cp\u003eSecondary data analyses were carried out using: 1) the Canadian Longitudinal Study on Aging (CLSA), a nationwide cohort study on adults living in private dwellings and aged 45\u0026ndash;85 at baseline (2012\u0026ndash;2015)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] which collected individual health, sociodemographic and neighbourhood data, 2) the Canadian census (2016)[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], for which all municipal demographic and income data were released, and 3) The Canada-wide Age-Friendly Survey (AFS)documenting key age-friendly components of municipalities (2017)[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. For the study\u0026rsquo;s objective, individual and municipal data had to be considered. The \u003cb\u003eindividual data\u003c/b\u003e were based on the CLSA\u0026rsquo;s respondents recruited in two cohorts, using a stratified random sampling strategy based on age, gender and province. Potential respondents were excluded if they could not communicate in English or French, lived in one of the three Canadian territories, were full-time members of the Canadian Armed Forces or lived on First Nations reserves or settlements. A comprehensive cohort (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30,111) was recruited among aging adults living within 25 km of a data collection site (or within 50 km in lower-density cities). A tracking cohort (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;21,241) recruited respondents from the ten provinces. In the present study, both cohorts were considered and respondents (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;41,400) were included if they lived in municipalities (\u003cem\u003em\u003c/em\u003e\u0026thinsp;=\u0026thinsp;170) that had at least 30 CLSA participants, a group size found sufficient to produce reliable coefficient estimates for linear multilevel models[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. For the \u003cb\u003emunicipal data\u003c/b\u003e, the 2016 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCanadian census\u003c/span\u003e was used to gather data about municipal demographic characteristics[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], specifically a) the material and social deprivation indices, as compiled by the National Institute of Public Health of Quebec[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], b) the urban/rural typology and c) demographic data. Moreover, the \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAFS\u003c/span\u003e questionnaire, documenting the key age-friendly components, was sent to all Canadian municipalities (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3,555)[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]; and was completed by the mayor or a person appointed by the mayor. A total of 921 municipalities (27.0%) completed the AFS questionnaire, mostly from Quebec, the Prairie provinces (Alberta, Saskatchewan and Manitoba) and Ontario. For the current study, the available sample comprises a total of 25,411 respondents living in 110 municipalities that completed the AFS, with at least 30 CLSA participants. The Research Ethics Committee of the Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke, approves this secondary analysis of the CLSA data (MP-31-2017-656).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eIndividual variables\u003c/h2\u003e \u003cp\u003eFrom the CLSA, the dependent variable, social participation, reports the frequency of participating in eight activities outside the home with others: family or friends outside the household, church or religious, sports or physical, educational and cultural, service club or fraternal organization, neighbourhood, community or professional association, volunteer or charity work, and other recreational activities. Responses are converted into the number of social activities monthly: \u0026ldquo;at least one a day\u0026rdquo; = 20; \u0026ldquo;at least one a week\u0026rdquo; = 6; \u0026ldquo;at least one a month\u0026rdquo; = 2; \u0026ldquo;at least one a year\u0026rdquo; = 1; and \u0026ldquo;never\u0026rdquo; = 0[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The number of monthly activities for each category is summed (theoretical range\u0026thinsp;=\u0026thinsp;0\u0026ndash;160; observed range\u0026thinsp;=\u0026thinsp;0\u0026ndash;146) and a higher score represents a higher frequency of participation. The instrument has good internal consistency (α\u0026thinsp;=\u0026thinsp;0.85)[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFive continuous variables from the CLSA were used to describe and compare characteristics of respondents: age, household size (excluding self), number of chronic conditions, depressive symptoms score (10-item Center for Epidemiologic Studies Depression scale [CES-D-10])[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], and social support score (Medical Outcomes Study [MOS] Social Support Survey)[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The CES-D-10 is a widely used instrument that estimates the weekly frequency of 10 items associated with depressive symptoms (e.g., being bothered, feeling fearful) and has shown good internal consistency (α\u0026thinsp;=\u0026thinsp;0.72)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The MOS Social Support Survey includes 19 items evaluating emotional, informational, tangible and affectionate support, and positive social interaction and presented good reliability (α\u0026thinsp;=\u0026thinsp;0.78) and a minimal detectable change of 1.57 among older adults[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThirteen other categorical variables from the CLSA were also considered: gender, immigration status, education level, marital status, household income class, retirement status, dwelling ownership, driver\u0026rsquo;s licence possession and use, absence of pain and discomfort and having had at least one fall in the last year, and functional limitations (basic and instrumental activities of daily living [ADL and IADL]). Both ADL and IADL measures were dichotomized (some limitations/no limitations) according to whether participants could perform all activities unassisted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMunicipal variables\u003c/h2\u003e \u003cp\u003eAll municipal data were measured or aggregated within municipal boundaries, which facilitated the merging with the CLSA data. From the \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e2016 Canadian census\u003c/span\u003e, the material deprivation index considers the proportion of persons without a high school diploma and employed, as well as the average personal income. The social deprivation index is based on the proportion of persons living alone, separated, divorced or widowed, and single-parent families[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Measured at the scale of the dissemination area (DA; a sub-municipal statistical unit embedded within the municipality\u0026rsquo;s boundaries) and grouped by quintiles, higher categories are associated with enhanced deprivation. Because the deprivation index was only available at the DA level, it was rescaled at the municipality level through a weighted average of the quintile of each DA encompassed by a municipality[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on Statistics Canada\u0026rsquo;s typology[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], municipalities were classified as urban or rural. The former includes adjacent municipalities centered on a city core, within census metropolitan areas (CMAs; \u0026ge;100,000 inhabitants) and census agglomerations (CAs; \u0026ge;50,000), and non-adjacent municipalities (\u0026ge;\u0026thinsp;10,000, known as fringe areas). The latter (rural) refers to non-urban areas within and outside CMAs and CAs. Finally, demographic data (all measured at the municipal level) included total population density (inhabitants/km\u003csup\u003e2\u003c/sup\u003e) and the percentage of the population aged 65 and over, within the municipality\u0026rsquo;s boundaries.\u003c/p\u003e \u003cp\u003eThe \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAge-Friendly Survey\u003c/span\u003e (AFS) is adapted[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] from the original survey designed by Menec and colleagues[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The AFS contains 56 items for which municipal age-friendliness is coded as: 1) yes, 2) no or 3) I don\u0026rsquo;t know. The items are categorized within nine key components (Appendix 1). Items answered yes were summed for each component, then standardized on a 0-100 scale for comparison, higher scores representing greater age-friendliness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis\u003c/h2\u003e \u003cp\u003eParticipants and municipalities were described using means and standard errors for continuous variables, or frequencies and percentages for categorical ones.\u003csup\u003e33\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMultilevel models were used to identify key age-friendly components (level-2) of municipalities best associated with individual social participation (level-1). First, a null model calculated the intra-class correlation and proportion of the total variation explained at the municipal level. Second, individual covariables (age, sex and functional limitations in activities of daily living) were added and tested for fixed and random effects of their relationship with social participation. Third, the nine key age-friendly components were added. Fourth, interactions were tested between significant variables of the two levels. Lastly, other municipal variables were added (material and social deprivation indices, urban/rural classification, total population density and the percentage of the population aged 65 and over). At all steps, a backward elimination strategy with a \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was used to select the variables. In addition, as recommended, the CLSA Sample Weights[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] version 1.2 were applied for all analyses, which were carried out using HLM 8[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results ","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIndividual characteristics\u003c/h2\u003e \u003cp\u003eThe available sample comprises a total of 25,411 respondents living in 110 municipalities that completed the AFS. Aged between 45 and 89 years, most respondents engaged monthly in an average of 20 social activities with others and lived with at least another person (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Respondents also reported an average of three chronic conditions, few depressive symptoms and good social support. Equally distributed according to sex, most respondents had a post-secondary education and household income below 100,000 CAD, were living in a couple, were free of discomfort, were owners of their dwelling, had a driver\u0026rsquo;s license and used it, and could accomplish their ADL. Almost one respondent out of five was born outside of Canada, a third were retired and one in ten had fallen during the previous year (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). When compared to the total CLSA sample (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;51,352), those in the present study had had one less activity per month on average (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; data not shown) and fewer chronic conditions (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Respondents in the current study were also statistically less likely to be female (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), be born outside Canada (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), have a post-secondary education (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) or a household income above 50K CAD (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), live in a couple (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), feel pain or discomfort (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and not drive a car (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of respondents (n\u0026thinsp;=\u0026thinsp;25,411)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eContinuous variables\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en missing\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SE)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial participation (# activities / month)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.2 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.9 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of chronic conditions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.3 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepressive symptoms (CES-D-10 score)\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.4 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHousehold size (including respondent)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMOS Social support score\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.8 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCategorical variables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en missing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale (vs. male)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12,981 (50.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImmigrant (vs. born in Canada)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,489 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePost-secondary education (vs. no post-secondary)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20,821 (83.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIn a couple (vs. alone)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16,800 (73.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHousehold income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;20K CAD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,997 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e20K \u0026ndash; \u0026lt;50K CAD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9,412 (33.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e50K \u0026ndash; \u0026lt;100K CAD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,746 (32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e100K \u0026ndash; \u0026lt;150K CAD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,845 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;150K CAD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,142 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFully or partly retired (vs. not retired)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14,186 (44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHomeowner (vs. non-homeowner)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21,164 (85.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas a driver\u0026rsquo;s license\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22,251 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,471\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrives a motor vehicle (primary transportation)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17,608 (71.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbsence of pain or discomfort (vs. pain)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14,617 (58.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,485\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFell last year (vs. did not fall)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,735 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,469\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eActivities of daily living (ADL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24,644 (97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInstrumental activities of daily living (IADL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23,809 (94.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eSE: standard error; unweighted n and weighted %. \u003csup\u003ea\u003c/sup\u003e 10 items answered on a 4-level scale (0\u0026thinsp;=\u0026thinsp;rarely or never; 3\u0026thinsp;=\u0026thinsp;all of the time), then summed (0 to 30), with higher scores indicating greater depressive symptoms[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. \u003csup\u003eb\u003c/sup\u003e 19 items answered on 5-level scale (1\u0026thinsp;=\u0026thinsp;none of the time; 5\u0026thinsp;=\u0026thinsp;all of the time), then summed (0\u0026ndash;100), with higher scores indicating more support[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eMunicipal characteristics\u003c/h2\u003e \u003cp\u003eMunicipalities that had at least 30 CLSA respondents but did not complete the AFS questionnaire (\u003cem\u003em\u003c/em\u003e\u0026thinsp;=\u0026thinsp;60) did not differ from those that did (data not presented). Municipalities were mainly urban with a density less than 1,000 inhabitants per km2, about a fifth of their total population was aged 65 and older and their material and social deprivation were above the Canadian median, indicating greater deprivation (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Most municipalities reported high levels of age-friendliness overall but varied according to the key components: Respect and social inclusion, Outdoor spaces and buildings, as well as Community and workforce participation (which includes opportunities for volunteering). Municipalities reported lower age-friendliness for Communication and information adapted for an older population and adapted and affordable Housing.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of municipalities (m\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eContinuous variables\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SE)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDensity (persons/km\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e887.8 (93.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePopulation aged 65+ (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.8 (0.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaterial deprivation index (weighted average)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.7 (0.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial deprivation index (weighted average)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.8 (0.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKey age-friendly components score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutdoor spaces and buildings\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75.8 (21.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSafety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.5 (32.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial participation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.6 (22.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity and workforce participation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.1 (26.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunication and information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.2 (23.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespect and social inclusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.0 (25.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHousing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.0 (30.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransportation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.7 (24.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity support and health services\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.9 (22.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCategorical variables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUrban (vs. rural)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (73.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAFC: Age-friendly components; SE: standard error\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the null model, 2.5% of the social participation variance was explained at the municipal level, regardless of their characteristics or key age-friendly components (data not shown). Accounting for individual and municipal characteristics, the final model is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Regarding the individual-level variables, higher social participation was associated with older age, being female, having a post-secondary education, living alone, having fewer chronic conditions and depressive symptoms, being retired, having a higher household size, more social support, a driver\u0026rsquo;s license, and no functional limitations. The only random slope was for the relationship between social participation and age, which indicates that this relationship varies across municipalities. Municipal variables had a significant effect on the intercept, with the final model showing that higher social participation was associated with lower material deprivation, higher age-friendliness of Outdoor spaces and buildings, and lower Communication and information (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). No interaction was found between age and key AFC, which means that the varying relationship between age and social participation across municipalities could not be explained by age-friendly components.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFinal model from multilevel regression for the social participation of aging adults in Canadian municipalities (n respondents\u0026thinsp;=\u0026thinsp;25,411; n municipalities\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFixed effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoef.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et-ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntercept\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eMunicipal characteristics (level-2)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaterial deprivation index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKey age-friendly components\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutdoor spaces and buildings\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunication and information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eIndividual characteristics (level-1)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale (vs. male)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePost-secondary education (vs. no post-secondary education)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIn a couple (vs. alone)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of chronic conditions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepressive symptoms (CES-D-10)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-7.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFell last year (vs. did not fall)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFully or partly retired (vs. not retired)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHousehold size\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMOS social support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas a driver\u0026rsquo;s licence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo limitation in activities of daily living\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo limitation in instrumental activities of daily living\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRandom effect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eVariance component\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003edf\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eχ\u003c/b\u003e\u0026nbsp;\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel\u0026nbsp;1 effect, r\u003c/b\u003e\u003csub\u003e\u003cb\u003eij\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntercept (social participation mean), u\u003c/b\u003e\u003csub\u003e\u003cb\u003e0j\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e345.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge slope, u\u003c/b\u003e\u003csub\u003e\u003cb\u003e1j\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e182.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eCoef: coefficient; SE: standard error; df: degrees of freedom\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to identify key age-friendly components best associated with the social participation of older Canadians. Although social participation has been essentially explained by individual factors, the present multilevel study showed that higher social participation at the individual-level was associated with two key age-friendly components of municipalities, Outdoor spaces and buildings and Communication and information, as well as lower material deprivation. In addition, material deprivation was the only other municipal characteristic also associated with the social participation of aging adults. The relationship between age and social participation was also different across municipalities.\u003c/p\u003e \u003cp\u003eIn line with other studies[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], age-friendly outdoor spaces and buildings facilitated the social participation of aging Canadians. Well-maintained, outdoor and walking environments enable older adults to move around in their community in a safe manner. For example, timely snow clearing was the most reported item from the outdoor spaces and buildings component[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], an essential factor for mobility during Canadian winters. Similarly, an age-friendly environment (\u003cem\u003ee.g.\u003c/em\u003e, accessible public restrooms, buildings and stores and active transportation infrastructures) has been found by other studies to be a known social participation facilitator[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], which increases the likelihood that a person will go outside and enjoy their getting to their activity and participating. Contrary to previous studies, which highlighted its importance for active aging[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], this study reported that a less age-friendly Communication and information component was associated with slightly higher social participation. Although this result should be further investigated, this association might be explained by the fact that informal networks compensated for and enhanced social participation in the absence of official documentation in languages other than French and English, or services aimed at helping them complete official forms. Additionally, Communication and information was a key age-friendly component within the lowest average scores, possibly because providing elder advocacy services and documentation in non-official languages may only be applicable to larger municipalities with a greater share of immigrants, where smaller municipalities may be less age-friendly, but still facilitate social participation. The importance of a digital divide and informal network of communication should also be further investigated. Recent research with older adults and local actors in the Eastern Townships, Quebec, Canada[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] showed how communities rely on on newsletters, directories, resource booklets and door-to-door outreach to increase awareness of available activities and promote social participation and health equity. Exploring the individual items in the Communication and information component could be insightful.\u003c/p\u003e \u003cp\u003eThe study confirms the association between social participation and material deprivation, suggesting that thriving and wealthier communities would have policies and resources in place to facilitate mobility and opportunities for social activities[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A British longitudinal study found that materially-deprived neighborhoods have limited a wide range of social activities for older adults, including civic and leisure participation, as well as activities with family and friends[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The authors also found that the participation of aging adults decreased at a faster rate in more-deprived versus more-affluent neighborhoods, making them vulnerable to social isolation. Nonetheless, reducing material deprivation of municipalities with aging populations can foster social participation, notably by providing the older population with more opportunities for social interactions and options for adapted housing.\u003c/p\u003e \u003cp\u003eAge was the only individual-level variable to have a significant random effect, indicating that municipal contexts may mediate the impact on the association between social participation and age. Although previous research showed that age is a significant predictor of social participation[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], the present results reveal that municipal characteristics not included in the models may facilitate or impede how older Canadians of various ages engage in social activities. For example, mixed-use zoning could facilitate getting outside of one\u0026rsquo;s home to accomplish activities of daily living and (spontaneously or intentionally) meeting with other people, which could be relevant when mobility is restricted. In addition to using the AFS to assess the municipal age-friendly components, a qualitative assessment of the neighborhood may explain how municipal contexts interact with age to foster or impede social participation, while taking into account the heterogeneity of aging populations[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eTo our knowledge, this study is the first to use extensive data nested in municipalities to explain social participation. The large sample size of participants and municipalities, applied with the weighting matrix, enabled population-level inferences. This study also has some limitations. Discarding municipalities with fewer than 30 respondents for the purpose of multilevel modelling, resulted in excluding most rural areas, limiting generalization to all municipalities. Initially calculated at the DA level, material deprivation was rescaled using weighted averages at the larger municipal level, similar to other works[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], which reduced the variability of deprivation (F\u0026thinsp;=\u0026thinsp;0.395l; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and possibly prevented observing a stronger effect. Lastly, municipalities might be too large to model the association between social participation and the environment. Although representing a diversity of neighbourhoods, some key components may nevertheless be attributable to the larger regional scale (\u003cem\u003ee.g.\u003c/em\u003e, transportation).\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion ","content":"\u003cp\u003eUsing population-based representative data and multilevel regression modelling, this study aimed to identify key age-friendly components of Canadian municipalities best associated with social participation of aging adults. Considering other individual and municipal variables, higher age-friendliness of outdoor spaces and buildings, and lower communication and information were associated with higher social participation. Additionally, the study confirmed the association of material deprivation with lower social participation of aging adults. Although social participation was primarily explained by individual factors, a multilevel approach exploring the municipal context provides grounds for testing theories and designing policies and interventions that could change behaviors and attitudes associated with age-friendly components. Because correlates of social participation may differ according to the types of activities respondents engaged in, future studies should consider analyzing finer spatial units, in addition to the profiles of social participation, rather than the total monthly participation. Overall, this study provides valuable insights to facilitate social participation and promote age-friendliness, by maintaining safe indoor and outdoor environments, and inclusively informing older adults of activities that are available.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Statement:\u0026nbsp;\u003c/strong\u003eThis study was supported by a Foundation Grant (#148466) from the Canadian Institutes for Health Research. M\u0026eacute;lanie Levasseur is a \u003cem\u003eFonds de recherche du Qu\u0026eacute;bec Sant\u0026eacute;\u003c/em\u003e (FRQS) Senior Researcher (#298996) and a Canadian Institutes of Health Research (CIHR) New Investigator (#360880). Parminder Raina holds the Raymond and Margaret Labarge Chair in Optimal Aging and Knowledge Application for Optimal Aging, is the Director of the McMaster Institute for Research on Aging and the Labarge Centre for Mobility in Aging and holds a Tier 1 Canada Research Chair in Geroscience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eThis research was made possible using the data/biospecimens collected by the Canadian Longitudinal Study on Aging (CLSA). Funding for the Canadian Longitudinal Study on Aging (CLSA) is provided by the Government of Canada through the Canadian Institutes of Health Research (CIHR) under grant reference: LSA 94473 and the Canada Foundation for Innovation, as well as the following provinces, Newfoundland, Nova Scotia, Quebec, Ontario, Manitoba, Alberta, and British Columbia. This research has been conducted using the\u0026nbsp;CLSA Baseline Data Version 3.4 (tracking cohort) and 4.1 (comprehensive cohort), under Application Number 170314. The CLSA is led by Drs. Parminder Raina, Christina Wolfson and Susan Kirkland.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eMaterial and Social Deprivation Indices (MSDI), indexed to DMTI Spatial Inc. postal codes, were provided by CANUE (Canadian Urban Environmental Health Research Consortium). Material and Social Deprivation Indices (MSDI) used by CANUE were provided by the \u003cem\u003eInstitut national de sant\u0026eacute; publique du Qu\u0026eacute;bec\u003c/em\u003e (INSPQ). Indices were compiled for 1991, 1996, 2001 and 2011 Census data by the \u003cem\u003eBureau d\u0026rsquo;information et d\u0026rsquo;\u0026eacute;tudes en sant\u0026eacute; des populations\u003c/em\u003e [https://www.inspq.qc.ca/en/expertise/information-management-andanalysis/deprivation-index]. Please refer to the Material and Social Deprivation Indices dataset documentation available under the Data section of the CANUE website (www.canue.ca) for additional information.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclaimer\u003c/strong\u003e: The opinions expressed in this manuscript are the authors\u0026rsquo; own and do not reflect the views of the Canadian Longitudinal Study on Aging.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e: Data are available from the Canadian Longitudinal Study on Aging (www.clsa-elcv.ca) for researchers who meet the criteria for access to de-identified CLSA data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStatistics Canada. \u003cem\u003eTable 17-10-0057-01 - Projected Population, by Projection Scenario, Age and Sex, as of July 1\u003c/em\u003e. Ottawa, ON: Government of Canada, 2022.\u003c/li\u003e\n\u003cli\u003eStatistics Canada. 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Barriers and Facilitators to Social Participation in Older Adults: A Systematic Literature Review. \u003cem\u003eClin Gerontol\u003c/em\u003e 2021;\u003cstrong\u003e44\u003c/strong\u003e:359\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003eMaclure M, Bouffard A, Morin M-K \u003cem\u003eet al.\u003c/em\u003e Importance de la nature, des opportunit\u0026eacute;s d\u0026rsquo;activit\u0026eacute;s, de leur accessibilit\u0026eacute; et de leur publicisation pour favoriser la sant\u0026eacute; positive, la participation sociale et l\u0026rsquo;\u0026eacute;quit\u0026eacute; en sant\u0026eacute; d\u0026rsquo;Estriens \u0026acirc;g\u0026eacute;s. \u003cem\u003eSubmitted\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003ePrattley J, Buffel T, Marshall A \u003cem\u003eet al.\u003c/em\u003e Area effects on the level and development of social exclusion in later life. \u003cem\u003eSoc Sci Med\u003c/em\u003e 2020;\u003cstrong\u003e246\u003c/strong\u003e:1\u0026ndash;11.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-urban-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jurh","sideBox":"Learn more about [Journal of Urban Health](https://www.springer.com/journal/11524)","snPcode":"11524","submissionUrl":"https://www.editorialmanager.com/jurh","title":"Journal of Urban Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"CLSA, Community, Community-dwelling, Canada, Deprivation, Recreation, Communication, Local policy, Urban policy","lastPublishedDoi":"10.21203/rs.3.rs-2809278/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2809278/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMunicipalities can foster the social participation of aging adults. Although making municipalities age-friendly is recognized as a promising way to help aging adults stay involved in their communities, little is known about the key components (e.g., services and structures) that foster social participation. This study thus aimed to identify key age-friendly components (AFC) best associated with the social participation of older Canadians.\u003cstrong\u003e \u003c/strong\u003eSecondary analyses were carried out using baseline data from the Canadian Longitudinal Study on Aging (\u003cem\u003en\u003c/em\u003e=25,411) in selected municipalities (\u003cem\u003em\u003c/em\u003e=110 with ≥30 respondents), the Age-friendly Survey, and census data. Social participation was estimated based on the number of community activities outside the home per month. AFC included housing, transportation, outdoor spaces and buildings, safety, recreation, workforce participation, information, respect, health and community services. Multilevel models were used to examine the association between individual social participation, key AFC, and environmental characteristics, while controlling for individual characteristics.\u003cstrong\u003e \u003c/strong\u003eAged between 45 and 89, half of the participants were women who were engaged in 20.2±12.5 activities per month. About 2.5% of the variance in social participation was attributable to municipalities. Better outdoor spaces and buildings (p\u0026lt;0.001), worse communication and information (p\u0026lt;0.01), and lower material deprivation (p\u0026lt;0.001), were associated with higher social participation. Age was the only individual-level variable to have a significant random effect, indicating that municipal contexts may mediate its impact with social participation.\u003cstrong\u003e \u003c/strong\u003eThis study provides insights to help facilitate social participation and promote age-friendliness, by maintaining safe indoor and outdoor mobility, and informing older adults of available activities.\u003c/p\u003e","manuscriptTitle":"Key age-friendly components of municipalities that foster social participation of aging Canadians: results from the Canadian Longitudinal Study on Aging","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-04-18 09:03:05","doi":"10.21203/rs.3.rs-2809278/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accept as is","date":"2023-06-22T19:41:30+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2023-06-05T15:23:49+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-06-02T14:55:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-04-14T15:33:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Urban Health","date":"2023-04-12T11:52:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-urban-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jurh","sideBox":"Learn more about [Journal of Urban Health](https://www.springer.com/journal/11524)","snPcode":"11524","submissionUrl":"https://www.editorialmanager.com/jurh","title":"Journal of Urban Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"ceacf634-7ab2-4360-9d85-8d4abdd61045","owner":[],"postedDate":"April 18th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T22:29:38+00:00","versionOfRecord":{"articleIdentity":"rs-2809278","link":"https://doi.org/10.1007/s11524-023-00762-7","journal":{"identity":"journal-of-urban-health","isVorOnly":false,"title":"Journal of Urban Health"},"publishedOn":"2023-08-18 22:01:19","publishedOnDateReadable":"August 18th, 2023"},"versionCreatedAt":"2023-04-18 09:03:05","video":"","vorDoi":"10.1007/s11524-023-00762-7","vorDoiUrl":"https://doi.org/10.1007/s11524-023-00762-7","workflowStages":[]},"version":"v1","identity":"rs-2809278","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2809278","identity":"rs-2809278","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}