Principles and Approaches for Unifying an Age-Friendly Movement

Abstract

Age-friendly initiatives dispersed across sectors have the potential to coalesce into a broader movement. This article describes the concept of social movements and its relevance for bringing together efforts as part of an age-friendly ecosystem (AFE). It presents five shared principles and approaches for further unifying age-friendly efforts: a focus on policy, systems, and environmental change; leveraging relationships for change; positioning older adults as change agents; addressing ageism; and attending to aging equity and diversity. We discuss how these principles and approaches can foster opportunities for more strategic alignment to strengthen an age-friendly movement for the 21st century and beyond.

Key Words

social movements, collective impact, social change; environment, collaboration, gerontology, community

Dramatic gains in human longevity are among the greatest accomplishments of the 20th century. What might we similarly celebrate as foundational progress on aging for the 21st century? An emerging age-friendly movement has strong potential to constitute one such accomplishment.

Thirty years ago, Matilda White Riley—a sociologist of the life course—advanced the concept of “structural lag” to envision social change in aging. Focusing on the social institutions of family and work, she and her colleagues wrote, “Our failure to match in social structures the rapid gains in longevity, health, and style of life has the unintended consequences of creating a poor fit between social institutions and people’s capabilities and responsibilities at every age” (Riley et al., 1994, p. 2). More contemporaneously, there are growing calls for altering the building blocks of society—including communities, education, healthcare, public health, employment, human services, public affairs, and the like—for longer and healthier lives (e.g., Rowe & Khan, 2015).

Initiatives to foster institutional change in aging have stemmed, in part, from the World Health Organization’s (WHO) inaugural work on age-friendly cities and communities. In 2007, the WHO published its foundational guide for age-friendly cities, articulating a vision for age-friendly progress across multiple domains of community life (e.g., housing, transportation, information and communication; WHO, 2007). In 2010, the WHO launched its global network of Age-Friendly Cities and Communities, thereby creating a programmatic “on-ramp” for community leaders across geographies and systems levels to commit and work toward age-friendly progress. Such work has since expanded to models and initiatives targeting specific social institutions. In the United States, for example, The John A. Hartford Foundation has spurred many of these developments, including age-friendly healthcare in collaboration with the Institute for Healthcare Improvement (IHI; Fulmer et al., 2023) and age-friendly public health systems in partnership with Trust for America’s Health (TFAH, 2023).

Other institutions often positioned within the age-friendly ecosystem (AFE) include employers/workplaces, higher education, and home- and community-based services (Fulmer et al., 2023). Despite beginning efforts to align this work across sectors, great opportunity remains to further coalesce these initiatives into a more unified and broadly understood social movement.

Social movements vary in terms of their intended degree of social change (e.g., transformation versus reform), their organizational form (e.g., highly structured versus informal networks), and their scope or number of goals (Chatterjee, 2024). Nevertheless, social movements share several key features, including a focus on changing society, the inclusion of diverse sets of actors working toward change in various ways, and an aim to alter policies, practices, and societal-wide beliefs.

As Ness (2015) summarized: “What is a social movement? The term has multiple definitions, but perhaps the simplest one is the best: the coming together of large numbers of people to pursue a goal that they believe will improve society” (p. xix).

Following these insights, as a developing movement, “age-friendly” can refer to a broad set of efforts to make social institutions and society more responsive to population aging and more inclusive of people as they age. Inclusion refers to the integration and participation of individuals, groups, and communities in the “fundamental functions and relations of society” (Fudge Schormans, 2014, p. 6082). This focus is consistent with the idea that an AFE refers to environments that are responsive, health-promoting, equitable, engaging, active, and respectful of aging (Fulmer et al., 2023).

Age-friendly as a movement relates to the concept of an AFE and the dual meanings of “ecosystem,” both as an ecological unit consisting of interactions across organisms and their environments, as well as a network “considered to resemble an ecological ecosystem especially because of its complex interdependent parts” (Merriam-Webster, 2024). The first definition aligns with AFE as the aspirational goal of the movement, and the second is consistent with AFE as a network of actors operating within the movement, as described below.

AFE as the aspirational goal. Consistent with the first definition, we can consider an age-friendly movement as a collective set of efforts that are working to foster more AFEs for people as they age. The AFE in this sense offers the shared aspirational vision of an age-friendly society: A society in which various social institutions, as well as person-environment systems, relate to each other in ways that optimize individual and collective functioning as people age.

AFE as the network of actors. Following the second definition, the ecosystem also can refer to the diverse set of actors who are symbiotically connected, yet working in distinct ways, as part of a broader age-friendly movement. This sense of the term relates to Fulmer and colleagues’ (2023) characterization of the AFE as “a comprehensive, collectively built, ever-expanding platform whose goal is to improve quality of life for older adults around the world through enhanced, collaborative impact.”

Further Unifying the Movement: Delineating Shared Principles and Approaches

What can help better define and propel an emerging age-friendly movement? Presented below are unifying principles and approaches—both implicit and explicit, as well as actual and potential—across sector-specific initiatives. While some are more forthright within specific initiatives than others, all five are not only applicable, but essential for greater impact via greater collaboration, coordination, and shared identity across the emerging movement.

1. Targeting impact via policy, systems, and environmental (PSE) change

Consistent with the idea that a healthy ecosystem supports the well-being of all constituent organisms, we can conceptualize the goal of age-friendly efforts as improving outcomes for people as they age. However, age-friendly work is unique in pursuing these outcomes by targeting PSE change. This impact contrasts with programs and interventions that make change by focusing directly on individuals and groups. So, one defining characteristic across age-friendly efforts is to form and deliver interventions, programs, and initiatives that center mechanisms of change at organizational, network, and higher-systems levels. Focal outcomes, therefore, can be measured according to indicators of PSE change, such as policy adoption, network development, and altered social norms.

The promotion of PSE change is already an explicit part of Age-Friendly Public Health, with PSE change constituting one of six focal principles: “creating and leading policy, systems, and environmental changes to improve older adult health and well-being” (TFAH, 2023). This includes focused efforts such as local governmental policies that encourage complete streets for safer and more diverse modes of mobility; a focus on aging and older adults in community-health improvement planning; and environmental considerations that align with sustainability efforts such as universally designed homes for lifelong living, and attention to outdoor space design that engages people at all ages, life stages, and abilities.

Similarly, aligned initiatives such as age-friendly employment also seek to address policy and system change through human resource practices in recruitment, training, workplace conditions, and multigenerational teamwork. Changing systems conditions is also a focus of age-friendly community work, with evidence of impact in altering policies, resource flows, mental models, practices, and networks in localities (see Greenfield & Pope, 2025, for further discussion).

2. Cultivating and leveraging relationships as drivers of change

As described above, efforts across the emergent movement are fundamentally social change-making efforts: They aim to change the way people relate to each other and to improve interactions across organizations, social institutions, and people as they age. While data, evidence, and metrics are essential tools for motivating and monitoring change, mobilizing data for change is achieved through social processes. So relational processes—such as cross-disciplinary partnerships, multi-sectoral collaboration, communications, and leadership—constitute another shared principle or approach for an emerging age-friendly movement.

The social planning model for age-friendly communities has for a long time emphasized cross-sectoral teams and the strategic engagement of community decision-makers and residents as core to the model. More recently, however, discourse on age-friendly communities has emphasized a focus on relational processes. Multiple review studies on facilitators and barriers to AFC development have identified effective governance, leadership, and cross-sectoral partnerships as essential conditions for sustainability and impact (Forsyth & Lyu, 2023).

Moreover, there is growing interest in how theories of community collaboration—such as collective impact, asset-based community development, Strategic Doing, and community-based participatory research approaches—can strengthen age-friendly community practice (Greenfield et al., 2022). As further illustration, all “six C” practices in Age-Friendly Public Health pertain to community partner–focused activities that build relationships (TFAH, 2023). For example, indicators of “connecting” and “convening” include engaging new, or enhancing existing, relationships with partners.

3. Positioning older adults and others with relevant lived experiences as agents for change

A third principle addresses the positioning of older adults not only as focal beneficiaries of age-friendly efforts, but also as essential contributors to change-making processes, meaning that older adults represent the intended beneficiaries of age-friendly efforts and the change agents central to ensuring responsive programs and policies (Forsyth & Lyu, 2023; WHO, 2007).

Engaging older adults in age-friendly change-making aligns with long-standing efforts across disciplines to address voice and positionality in team-based processes, such as person-centered and transdisciplinary care, participatory planning models, coproduction, and allyship. Consistent with theorizing on diverse forms and levels of citizen participation, older adults and people with other relevant lived experiences can engage in age-friendly efforts—as one-time informants, program volunteers, champions, and project leads.

Organized networks for age-friendly community initiatives require the explicit engagement of older adults from the beginning, with applications to join such networks requiring that community leaders describe how older adults will be involved in the change-making process. Research also has found that community initiatives vary from top-down to grassroots, resident-led efforts, with some initiatives being entirely initiated, administered, and sustained by older adult residents (Black & Oh, 2023).

The Age-Friendly Health Care model further exemplifies the primacy of older adults through the first of its 4M principles. Addressing “what matters most” recognizes the centrality of older adult input for providers to translate person-centered care into clinical goals of practice within the trajectory of one’s health and across the continuum of healthcare settings (IHI, n.d.).

4. Addressing ageism at all levels

Ageism includes stereotypes (how we think), prejudice (how we feel), and discrimination (how we act) toward people based on age (WHO, n.d.). Ageism also manifests at the structural and institutional levels and refers to not only our attitudes, beliefs, and actions toward others, but also toward ourselves (Applewhite, 2016). Because work toward an AFE takes place in the context of a society characterized by ageism, actors throughout the emerging movement are called to reckon with pervasive negative societal treatment of older adults and aging.

Age-friendly efforts are now developing in the context of mounting campaigns against ageism that can be even more systematically incorporated across sector-specific initiatives. One prominent example of such a campaign is reframing aging, which aims to improve the public's understanding of aging via research, communication strategies, community-building, training, events, and guidance. (For other examples, refer to https://oldschool.info.)

The Age-Friendly University (AFU) initiative provides an example of how a sector-specific initiative exemplifies this principle (AFU Global Network, n.d.). Age-friendly universities espouse 10 guiding principles to encourage institutions of higher education to be more inclusive of people of diverse ages and enhance societal-wide preparedness for population aging. Though not explicit, several of the tenets address ageism at interpersonal and institutional levels. This includes encouraging the participation of older adults in all core university activities including intergenerational learning, which fosters exposure and sharing that can counter implicit bias toward older people.

AFU efforts also emphasize the integration of knowledge about the longevity dividend in course content, as well as curricular experiences that replace prevailing negative views about older people with nuanced understanding and positive perspectives about growing older. The AFU initiative further advocates for research agendas informed by the needs and strengths of older adults, providing students and university partners with better understanding of the complexity and richness that aging brings to our society.

5. Addressing issues of aging in the context of diversity and inequalities

Older adults have long been recognized as a diverse population group premised on the idea that, with the passage of one’s lifetime, there are increasing opportunities for bifurcation in life-course experiences and circumstances. Successive cohorts of older adults are becoming even more diverse given other demographic trends, such as widening socioeconomic inequalities and greater racial/ethnic diversity. While age-friendly efforts center on age as a focal social position in its own right, age-friendly leaders across the emerging movement are called to attend to issues of age at the intersection of other social categories (e.g., race/ethnicity, gender, disability, sexual orientation, economic status, family structure, etc.) in the context of interlocking systems of privilege/domination (racism, sexism, ableism, homophobia, etc.) that constrain or facilitate life-course opportunities and experiences of later life.

Several sector-specific initiatives are explicitly focused on aging equity. The WHO (2015) positioned equity as a cross-cutting principle to guide assessments of the age-friendliness of cities. In 2023, IHI released a report on how organizational leaders can address health equity at “every step” of their age-friendly healthcare “journey” (Southey & Henriquez Garcia, 2023). And most recently, TFAH has placed equity at the center of its model for age-friendly public health systems, aligning with the CDC’s revised model of 10 essential public health services (Wolfe & Barile, 2024).

Examples of ways in which age-friendly leaders across initiatives can orient to issues of aging equity include collecting and analyzing data to measure disparities across subgroups of older adults, developing and using better and more intentional practices to ensure leaders from historically marginalized communities are centered or represented in the work, and prioritizing actions likely to benefit individuals from historically marginalized groups in equitable ways. (For further discussion of considerations of equity for age-friendly communities, see Yeh et al., 2024.)

Conclusion

Now, a quarter of the way into the 21st century, is an opportune time to further coalesce age-friendly efforts into a stronger and more widely recognized movement. The existence of this special issue of Generations on the AFE demonstrates continued progress in positioning parallel efforts for amplified impact and reach. Today’s historical moment—including heightened awareness of societal responses to aging in light of the COVID-19 pandemic, the urgency of demographic change vis-a-vis the accelerating aging of our population, and efforts to elevate anti-ageism efforts as part of broader societal attention to diversity, equity, and inclusion—suggests growing readiness for fortifying and expanding this movement.

While recognizing the movement is in its nascence, the above-described principles and approaches can amplify sector-specific initiatives alongside the movement more broadly. For example:

• Sharpening a collective focus on PSE change can better center the movement on long-term sustainable impact over time.
• Orienting to the cultivation of relationships within and across sectors and stakeholders accentuates the importance of investing in collaborative leadership to develop capacity for age-friendly social change.
• Positioning older adults at the center across age-friendly efforts ensures that lived experiences guide strategic decision-making while working against ageist norms that relegate older adults as unilateral recipients of care.
• Explicitly calling for the movement to counter ageism at all levels—intrapersonal, interpersonal, and institutional—elucidates opportunities for sector-specific initiatives to align more programmatically for societal-wide change, such as through collective use of training resources and awareness campaigns.
• Centering diversity among older adults in the context of structural inequalities directs the movement’s attention upstream to earlier life stages and life-course conditions that perpetuate inequitable aging for older adults of today and tomorrow.

Delineating shared aspirations, as well as unifying principles and approaches across sector-specific initiatives, can help solidify an age-friendly movement. These connections can facilitate opportunities for more coordinated programmatic work and cross-sector impact, while allowing component initiatives to flourish on their own terms (i.e., in terms of focal goals, disciplinary leanings, key stakeholders, historical development, etc.). Such alignment as a social movement can help accelerate momentum toward the long arc of social change for, and on behalf of, an AFE in our lifetimes and for those to come.

Acknowledgments: The authors thank Natalie E. Pope for her review and feedback on an earlier version of this work, as well as Megan Wolfe, Karon Phillips, and Jody Shue.

Emily A. Greenfield, PhD, is a professor in the Rutgers School of Social Work in New Brunswick, NJ. Kathy Black, PhD, is a professor emeritus in the School of Aging Studies at the University of South Florida in Sarasota, FL.

Photo credit: Shutterstock/Tinnakorn jorruang

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