The Age-Friendly Ecosystem is a multi-sectoral framework that prioritizes improved quality of life for older adults through collaborative impact. Actively engaged sectors include healthcare systems, public health departments, the aging services sector, academia, businesses, and communities where the age-friendly concept has been adopted.
Age-friendly practitioners are performing transformational work in cities, rural areas, states, and communities of all sizes, through home- and community-based services, in academic settings and in the workplace, across health systems, and in public health endeavors around the world.
The promise of an Age-Friendly Ecosystem (AFE) that delivers improved quality of life and health outcomes for older adults through intentional, collaborative impact has yet to be realized. At present, systems of engagement, support, and care for older adults exist in a haphazard tapestry of healthcare, public health, and aging services, while research and data collection on older adult health and well-being remain inconsistent. Changes in policy and systems that lead to effective support and care for older adult health and well-being require collaboration and coordination across all sectors.
The Opportunity
The opportunity at hand is to consider how practitioners and sector partners can reach across the AFE and other initiatives and work collaboratively to coordinate policy, systems, programs, and services that benefit older adults as they navigate the interrelated aspects of their lives at home, in workplaces, in healthcare settings, and in their communities.
Trust for America’s Health (TFAH), with support from and in partnership with The John A. Hartford Foundation (JAHF), is leading efforts to coordinate sector engagement to develop strategies, tools, and resources that support stronger, more consistent, and active collaboration across all sectors of the AFE. Through its Age-Friendly Public Health Systems movement, TFAH is recognized as a leader in the public health sector of the AFE, plus holds expertise connecting and convening sectors, which then strengthens TFAH leadership in these collaborative efforts.
In 2024, TFAH convened leaders from more than 30 organizations representing perspectives from across the AFE for a multiday, in-person forum. The goals of this gathering were to 1) examine best practices that promote healthy aging at the national, state, and local levels; 2) identify shared priorities and strategies that deliver better outcomes for older adults and their friends and family caregivers; 3) explore opportunities for multi-sectoral collaboration and the mitigation of challenges and barriers to such collaboration; and 4) explore innovative tools and resources to facilitate such collaboration including needed policy, systems, and environmental improvements.
Post-event analyses confirmed attendee enthusiasm for a forward-looking, intentional approach to strengthening collaboration across various age-friendly sectors and revealed a strong desire for action and the creation of strategic pathways for effective coordination. Subsequent online convenings with dozens of partners across the AFE reinforced these concepts and goals.
‘Aligning and coordinating policies and programs for older people can lead to improved results in health and well-being.’
The need is great for leadership in all sectors, as fostering and managing cross-sector initiatives requires skill and resources to convene, build trust, provide tools, and shepherd meaningful solutions. Awareness of the AFE concept has begun to take hold in states and communities where individual champions and coalitions of thought leaders and practitioners lead efforts to transform governmental and community-based systems into cohesive and coordinated ecosystems of action and impact. But there is much more to do.
What We’ve Learned
Five themes emerged from the 2024 AFE Workshop that can and should inform future action: 1) Building Relationships and Trust, 2) Fostering Leadership Engagement, 3) Exploring Opportunities for Collaboration and Addressing Challenges and Barriers, 4) Identifying or Developing Innovative Tools and Resources, and 5) Considering Advocacy Opportunities, which are addressed below.
Building Relationships and Trust
The foundation for successful multi-sectoral collaboration is in building strong relationships and mutual trust among partners from diverse fields and sectors. To achieve this, organizations must intentionally create environments and opportunities that allow partners to deeply understand one another’s unique goals, challenges, and priorities, as well as areas of expertise.
Recent research on collaborative frameworks suggests that building relationships and momentum through tangible action may yield more effective results than extensive planning. Called “Strategic Doing,” this approach emphasizes immediate action with willing participants on feasible, short-term projects, and prioritizes relationship-building and tangible collaboration over system-wide planning.
Identifying or Developing Innovative Tools and Resources
TFAH works with AFE partners to identify and/or develop tools and strategies that can be put into action, including the creation of a curated “Model Practices” library featuring case studies from domestic and international sources. This library could serve as an invaluable resource for local leaders seeking adaptable solutions. Importantly, the co-creation of collaboration tools and resources to support and improve the integration of services (and data and best practices exchange) across sectors is paramount, alongside the development of a comprehensive, cross-sectoral practitioner database to foster network growth. A particularly innovative proposal involves expanding TFAH’s AFE map tool into a dynamic database of age-friendly champions across all sectors.
Fostering Leadership Engagement
Alongside developing tools and strategies, ensuring effective and engaged leadership is indispensable in fostering age-friendly collaborations and navigating complex power dynamics across sectors. Visionary leaders, funders, and policy makers who embrace multi-sectoral collaboration are crucial to drive meaningful and sustainable change, promote inclusive initiatives, and orchestrate diverse stakeholders to achieve shared goals, even amid ever-shifting political landscapes.
By elevating the work of those who champion collective impact approaches, we look to celebrate and cultivate a new generation of leaders with the skills, networks, and mandates to involve stakeholders from across sectors (including governments at all levels) to support aging-related initiatives through coordinated strategic planning, funding, programming, and policy. This must become the norm rather than the exception.
Exploring Opportunities for Collaboration and Addressing Challenges and Barriers
Various barriers to multi-sectoral collaboration include the “implementation gap” between planning and action. Where some see challenge, others see opportunity. Exploring the connections between Multi-Sector Plans on Aging (MPAs) and the AFE has emerged as one such area of opportunity, possibly offering a unique chance to enhance the effectiveness of both efforts to support older adults. AFEs and MPAs both play crucial roles in coordinating leadership, allocating resources, leveraging existing coalitions, and enhancing programs that support older adults.
This issue illuminates practice silos while exploring opportunities for collaboration of ecosystem partner work.
Importantly, a well-functioning AFE can act as a catalyst for accelerating MPA implementation. To realize this aspirational goal, TFAH is investigating strategies to curate and disseminate best practices, examples, and policies that facilitate state-level coordination of aging initiatives. This effort raises important considerations, such as how partners can support MPA development teams in aligning with existing AFE-facilitated programs and services, and how to effectively harmonize MPA goals with AFE partner capabilities and local knowledge. The ultimate aim is to create a clear pathway from conceptual planning to real-world application, leveraging the strengths of MPAs and AFEs to create more comprehensive and effective support systems for older adults.
Supporting Advocacy Opportunities
Many challenges noted above may require policy and systems change, providing another path for collaborative action through advocacy at all levels. Policymakers generally are not aware of the opportunities for coordinating programs and services, expanding data collection and research, and leveraging limited financial resources to better serve older people in their jurisdictions. AFE partners should consider and align advocacy efforts to educate and seek more resources for programs and services that are needed now and will be needed in the future.
Moving Forward
In planning for this special issue of Generations, which TFAH was invited to guest edit, our goals were many: 1) to galvanize interest and momentum across and within the sectors of the age-friendly ecosystem; 2) to build awareness about each sector; 3) to illuminate existing practice silos while exploring opportunities for collaboration of ecosystem partner work; and 4) to create national interest in and commitment to multi-sector collaboration and coordination of age-friendly policies, programs, and supports.
Many authors who were invited to join TFAH in this endeavor represent sectors of the AFE working at various levels and locations. They were asked to provide historical context, showcase collaborations, highlight innovative policies and practices from within and sometimes across sectors, and elevate efforts that are building transformative collaborations and partnerships to advance the health and well-being of all people. They also were asked to share challenges and obstacles to this work. This special issue now serves as a comprehensive repository of information and insights for each relevant sector.
It offers historical perspectives, reflects on the imperative to prioritize equity in all of our work, provides examples of age-friendly work in rural and international settings, and showcases collaborative efforts.
Now more than ever, leaders across the AFE are presented with a unique and pressing challenge to align and coordinate their work so that it may deliver improved results for older people. The significant strides made in fostering mutual understanding among practitioners and providers across all sectors are critical waypoints toward this goal.
Why? Because this enhanced awareness is the bedrock upon which future collaborations can be built, and as sectors become more cognizant of one another’s work, the likelihood of meaningful partnerships and the harmonization and synthesis of diverse workstreams increases exponentially.
But the growing momentum and enthusiasm for actionable cross-sector collaboration is a beginning, not an end point. What is needed are actionable, useful strategies, tools, and resources that enable precisely the kinds of multi-sectoral collaborations that deliver results. This work is challenging, but it is imperative that we move beyond theoretical ideas about collaborative impact and translate shared knowledge from across the AFE into practical, do-able, strategies and actions.
If we can do this, we can accelerate the creation of more integrated, responsive, and effective Age-Friendly Ecosystems that truly serve the diverse needs of older adults.
Curating the essential, cross-sectoral knowledge found in this special issue can further catalyze more informed and actionable collaborations among AFE partners and others through shared knowledge that could spark curiosity, ideas, and enthusiasm for a path forward, and ultimately strengthen the fabric of multi-sectoral partnerships in the AFE. TFAH looks forward to working with AFE partners, all interested organizations, agencies, practitioners, and older people to support a harmonized, age-friendly ecosystem that delivers.
Guest Editor Karon Phillips, PhD, MPH, CHES, is policy development manager, and Guest Editor Megan Wolfe, JD, is senior policy development manager, both at Trust for America’s Health in Washington, DC. Jody Shue, MPH, has served as the executive director of the Age-Friendly Institute and as an instructor at Boston University's School of Public Health. Now a consultant, she leads initiatives to develop the Age-friendly Ecosystem and ran the state-wide Age-Friendly Rhode Island program.
Photo credit: Shutterstock/Aleksandr Simonov
