Growing older in world cities: Themes, interpretations, and future research

The unprecedented convergence of population aging and urbanization presents great challenges and opportunities for cities and their older residents. The chapters of this book provide a detailed account of how the four largest cities in some of the wealthiest nations of the world-New York, London, Paris, and Tokyo-are confronting these changes. One challenge that each of these cities confronts is how to balance the desire of most people to age in place with the tremendous cost of growing older in world cities. One response to this challenge has been to disperse frail older persons out of the urban core of each city. Over the coming decades, these cities, and no doubt many others, will have to decide whether to continue sending large numbers of older persons to facilities outside the city when they become too frail to care for themselves, or whether to invest in alternatives that make aging in place a possibility for more residents. Many of the institutions, neighborhood characteristics, and other social factors that influence the health of older people may be beyond the reach of city government and must be addressed at the national level. Cities are limited in their ability to redistribute income and address neighborhood-level poverty and inequality.31 Similarly, many environmental issues must be addressed at a regional level.32 Nevertheless, we should not underestimate the ability of city governments to address social issues, including the health and well-being of older residents.33 Nor should we overestimate the capacity of the existing national welfare states to serve those who fall through the cracks of a host of health and social welfare programs. Cities and other local governments address many social problems that are not addressed adequately by the national government. In the wake of September 11 and the Paris canicule of 2003, the need to address the needs of vulnerable older persons living in cities is more apparent than ever. Older persons-particularly isolated older persons-are typically an invisible population that does not receive attention from policy makers, the media, or the general public. Greater appreciation of the needs of this vulnerable population is probably the only positive outcome from these catastrophic events.