A Grounded Theory of Walking for Health Promotion in Older Urban Adults

Abstract

Background and Objectives

Walking enhances the health, quality of life, and independence of older adults. However, a global decline in urban walking necessitates a re-evaluation of segmented, quantitative approaches to policies and theoretical frameworks in geriatric medicine for promoting walking among older adults. This study conceptualized the perceptions, experiences, and behaviors regarding walking, from a health promotion perspective, among older urban adults.

Research Design and Methods

Pedestrian-friendly communities were explored for older adults in Seoul, South Korea, using a grounded theory. Thirty-eight older adults actively engaged in walking were recruited between July and December 2020. A qualitative multimethod approach was used, and the collected data were analyzed using open, axial, and selective coding, with axial coding integrating textual and spatiobehavioral information.

Results

The open-coding process yielded 92 concepts, 47 subcategories, and 19 categories. Using axial and selective coding principles, a conceptual framework was developed to explain how walking shaped the daily lives of older urban adults and provided multidimensional health benefits. Walking perception attributes were characterized by “embodied subjectivity as a healthy older adult,” “autonomy of movement,” and “walking as a way to enrich or sustain life.” Active walking facilitated interactions between older adults and their neighborhood environment within the context of compact and accessible urban living.

Discussion and Implications

A healthy and age-friendly community encourages interactions between older adults and their neighborhood environment by providing opportunities for daily walking for several purposes, such as providing a sense of autonomy, increasing health-promoting behaviors, and creating a sense of community.

Background

Walking is a key health behavior associated with various benefits and indicators of well-being in older adults (Ory et al., 2016), including its role in assessing health status. Previous studies have highlighted the role of walking in old age to enhance activities of daily living (Kizony et al., 2020), prevent pathological aging (Oveisgharan et al., 2023), and improve aerobic endurance, lower limb strength, mobility, and mental health (Magistro et al., 2014; Yu et al., 2023). Walking also promotes social engagement and leisure activities, indicating its multifaceted benefits in older age (Lee & Tan, 2023).

Walking forms part of the national urban health strategies of several countries, as a simple, accessible way to promote health in older adults. In 2007, the World Health Organization (WHO) introduced age-friendly city guidelines, emphasizing the need to foster pedestrian-friendly environments and enable older adults to walk in neighborhoods (WHO, 2007). These guidelines stress expanding leisure and economic opportunities, encouraging natural social engagement, and forming care networks; the WHO employs them as certification standards for the Global Network for Age-Friendly Cities and Communities, reporting on global efforts to create walkable environments for older adults (WHO, 2018).

Despite these efforts, globally the prevalence of walking among older urban adults has declined over the past decade; the Global Physical Activity Survey (WHO, 2022) shows a worldwide decline in the proportion of older adults who regularly walk in urban areas, from 34% in 2012 to 28% in 2022. This decline is pronounced in high-income and aging countries. The proportion of older urban adults who walk regularly decreased from 40% in 2012 to 32% in 2022 in the United States; Australia (36%–30%), New Zealand (34%–28%), Spain (29%–25%), Japan (35%–29%), and South Korea (30%–26%). Thus, a re-evaluation of the existing policies and approaches regarding walking in older urban adults, based on theory and practice, is imperative.

Understanding how older adults navigate complex urban environments is critical to public health as urbanization transforms cities. Seoul, a leading city grappling with global aging challenges, illustrates the importance of this issue (Woo & Choi, 2022). Studying older adults’ interactions with their surroundings is essential in this densely populated metropolis, known for its diverse destinations and vibrant urban life (Kim & Yoo, 2019). Investigating how the walkability of neighborhoods affects their physical activity levels is critical. Walkable neighborhoods with well-maintained sidewalks, diverse destinations, and mixed land uses promote active living and improve the well-being of older adults (Christman et al., 2020). This research informs the creation of age-friendly cities that promote healthy and active aging.

Geriatric medicine focuses on theoretical models that evaluate walking in older adults, with an emphasis on gait impairment. This perspective assumes a linear relationship between walking and factors such as measures of physical function (e.g., step count, walking speed), health indicators (e.g., cardiovascular health), and environmental conditions (e.g., walking terrain) (Kamaruzzaman, 2018; Zhang et al., 2019). However, this assumption and the quantification-oriented approach result in a limited explanation of the meanings, conditions, and contexts in which older urban adults walk, or the processes by which these practices lead to health-promoting effects, with existing theoretical models. To ensure the sustainability of policies promoting walking among older adults, policy-makers need compelling evidence of policy effects. Developing a contextual and process-oriented theory is essential. This theory, drawing on lived experiences, should explain the continuum from walking practice to health outcomes among older urban adults.

Objectives

This study aimed to conceptualize the perceptions, experiences, and behaviors of older urban adult walkers from a health promotion perspective using a grounded theory approach. The research questions used to generate the grounded theory were as follows: What are the walking perceptions, experiences, and behaviors among older urban adults in Seoul, and how are they constructed? How do the unique contextual factors surrounding older urban adults in Seoul influence their active walking, and in what ways does the active practice of walking by older urban adults in Seoul contribute to its health-promoting effects within the complex urban milieu?

Research Design and Methods

This study utilized a grounded theory approach, a qualitative research method that develops theories grounded in field evidence. It involves constructing new theories or gaining insights into social phenomena based on observations and interactions (Strauss & Corbin, 1998). By analyzing field data collected from behaviors, interactions, and social processes, researchers aim to develop a middle-range theory that captures new conceptualizations or relationships within a specific context (Kwon, 2016).

Middle-range theory (Meleis et al., 2000) articulates the characteristics of grounded theory, particularly in the social sciences, which aims to establish valid theories within specific social contexts. Kwon (2016) highlights its main goal: To expand knowledge about a phenomenon by capturing new conceptualizations or relationships within real-world situations. In essence, grounded theory is critical to advancing our understanding of social phenomena by bridging theoretical abstraction and empirical observation within specific contexts. The use of grounded theory can help elucidate walking perceptions, experiences, and behaviors among older urban adults.

Setting

This study was conducted in a single neighborhood in Seoul, a city that promotes pedestrian- and age-friendly environments (Lee & Jung, 2019). The study area was selected by analyzing data from the 2017 Korea Community Health Survey to identify hotspots with a high prevalence of walking among older adults in Seoul. From the identified hotspots, the study area with the highest value on the pedestrian-friendly environment index was then selected (Kang, 2013) and measured using public administration data. This involved selecting a specific community that provided a walkable environment for older adults and with a high likelihood that older adults were actively engaged in walking. This specific community was chosen so that the walking experiences and behaviors of older adults, as well as the interactions between older adults and their environment, could be richly incorporated as conceptual elements within the grounded theory.

Study Participants

Study participants were selected using the grounded theory approach, employing the theoretical sampling principle (Drucker et al., 2007), specifically targeting adults ≥65 years. We targeted older adults who walked and met the WHO guideline of at least 30 min/day, for 5 or more days per week (WHO, 2010). Participant recruitment employed active methods (e.g., targeted announcements via community centers) and passive methods (e.g., distributing flyers in public spaces and word-of-mouth referrals). Led by the first author with support from a research assistant, this approach ensured comprehensive coverage of potential participants.

Initial recruits came from social welfare facilities, and additional participants were added through snowball sampling. To bridge data gaps, we conducted additional sampling and noted that participants’ residential areas significantly influenced their walking routes and interactions. Participants from apartments and multifamily houses were recruited and categorized according to sex (male/female) and age (under/over 75 years). They were then divided into eight groups (2 × 2 × 2) based on sex, age, and housing. The exclusion criteria included cognitive impairment, recent moves (<1 year), and long-term care. Recruitment stopped at theoretical saturation (Strauss & Corbin, 1998), where no new data emerged, aligning with Guest et al.’s (2006) guidelines. Overall, 38 participants were included, ensuring diverse representation. The number of people contacted for recruitment was not accurately and systematically recorded; we estimate that approximately 120 people were contacted, which was more than three times the final number of participants.

Data Collection

This study used a qualitative multimethod approach, combining descriptive data collection through individual in-depth interviews and spatiobehavioral data collection through field observation and mobile Global Positioning System (GPS) tracking. Data were collected from July to December 2020, during the first level of the Coronavirus Disease 2019 (COVID-19)-related social distancing measures in South Korea, when gatherings, social events, and access to multiple facilities were allowed.

First, face-to-face surveys were conducted to collect demographic information, including age, sex, residence type, household type, frailty (Fried et al., 2001), subjective health status (on a 5-point scale), and mental health status (using the Patient Health Questionnaire-9; Han et al., 2008). Individual in-depth interviews were then conducted to explore various aspects of walking, such as perceptions, behaviors, environmental influences, community contexts, and health effects. The semistructured interview guide, developed collaboratively based on a literature review, was pilot tested with a village head for clarity and comprehensiveness. The results of the pilot, including analysis of feedback from the village head, were incorporated into the data analysis. The interviews, conducted by the first author and the research assistant in convenient locations like coffee shops or participants’ homes, averaged 78 min. Audio recordings were transcribed into electronic documents within 3 days.

The first author, supervised by the corresponding author, conducted field observations. They developed guidelines for using the Age-Friendly Walkable Urban Space Community Assessment Tool (Almeida, 2016) and received training to ensure consistent criteria application. The study area was observed on foot, with location information manually recorded. Additionally, they visited walking routes and places mentioned by participants in interviews to cross-check the data.

Mobile GPS has the advantage of tracking participants’ movement paths in real time, making it easy to track their daily activity radius (Kerr et al., 2011). We used a mobile GPS device (Polar M430, manufactured by Polar Electro, Kempele, Finland) to explore the extent of the participants’ daily walking activity radius and identify the locations of their movement paths and resting places. The GPS device software enabled online collection of distance, duration, and speed, which were automatically stored daily on Google Maps. We recommended that the study participants wear the Polar M430 for two weekdays and one weekend day.

Data Analysis

Descriptive data collected through the individual in-depth interviews underwent grounded theory analysis (Strauss & Corbin, 1998), which included open, axial, and selective coding. During the open-coding process, the interview content was meticulously examined to identify meaningful entities of the walking perceptions, experiences, and behaviors of older urban adults, alongside aspects related to health promotion. Regular team meetings were held to deliberate on emerging concepts, fostering consensus through iterative discussion. Additionally, extensive review and discussion among researchers occurred at key stages of the grounded theory process, including debriefing sessions and codebook development. These collaborative efforts allowed for a thorough examination of the data, enriched the analysis, and contributed to the rigor of the study. The first author, as the primary coder, analyzed under the supervision of the corresponding author, further ensuring the integrity and reliability of the findings. By thoroughly exploring the relationships among these entities, 92 concepts emerged, subsequently categorized into 47 subcategories and 19 overarching categories (Supplementary Table 1). Employing a constant comparative method, we ensured that the derived concepts and categories aligned with the study’s overarching questions and encompassed the entire data set.

In the axial coding stage, the identified subcategories and categories were organized according to the coding paradigm areas. By drawing the relationships between the categories as a diagram, we inferred a central phenomenon. The concepts and categories that explained the central phenomenon were organized. The remaining categories and concepts were systematically related based on their causal conditions for engagement in walking, contextual conditions that influenced walking, intervening conditions that influenced walking frequency, interactions between older adults and the environment through walking, and health-promoting outcomes of walking (Figure 1).

During selective coding, we generated three core categories and two underlying contexts that encompassed the results of the coding paradigm, based on the Strauss (1987) core category selection criteria. By linking the core categories and contexts, the emergent stories of older urban adults’ walking for health promotion were transformed into a conceptual framework based on grounded theory.

Analysis of the spatiobehavioral data collected through field observation and mobile GPS tracking was integrated into the core phenomenon and contextual condition stages of the coding paradigm. By categorizing and comparing the results based on the central phenomenon, various contextual conditions related to the walking perceptions, experiences, and behaviors of older urban adults were identified. Integrated analyses derived from the central phenomenon were used for triangulation to ensure the credibility of the findings.

Trustworthiness of the Study

We ensured the trustworthiness of the study by following the critical evaluation criteria for qualitative research (Hannes, 2011), which include truthfulness, applicability, reliability, and neutrality. To this end, we implemented several strategies, including the triangulation of data sources to enhance truthfulness, the application of the Standards for Reporting Qualitative Research (O’Brien et al., 2014) to broaden applicability (Supplementary Table 3), and the promotion of reliability through regular feedback and collaborative coding refinement during peer debriefing sessions. To increase neutrality, we authored reflective commentary addressing the biases and perceptions of older adults before commencing the study.

Researcher Characteristics and Reflexivity

The research team consists of two experienced researchers: the first author, a male in his 30s based in Seoul with a degree in public health specializing in active lifestyles of older adults in urban settings, and the corresponding author, a female in her 50s who provided consulting support. Both authors are well versed in qualitative case-study methodology and urban community health studies, and share a socioecological perspective on active living and healthy aging. In constructing grounded theory, the first author adopts a pragmatist perspective, focusing on intervention strategies and health outcomes, whereas the corresponding author, who favors a constructivist paradigm, emphasizes the construction and interactions between concepts. This blend of perspectives allows for a comprehensive discussion of grounded theory.

Reporting of Findings

The findings of this qualitative study are presented following the guidelines set out in the Standards for Reporting Qualitative Research (SRQR; O’Brien et al., 2014; Supplementary Table 3). The qualitative findings and quotes were translated with the assistance of a professional editing company. Throughout the translation process, careful consideration was given to both the words and meanings of the original responses to ensure the accuracy and fidelity of the original data.

Ethical Considerations

This study was conducted according to a protocol approved by the Institutional Review Board (IRB) of Seoul National University (IRB number: 1910/002-016). Informed consent was obtained from the participants to record and conduct interviews and to wear mobile GPS devices; moreover, they could withdraw from the interview and study whenever they wanted.

Results

General Characteristics

Women made up approximately 52.6% of the sample of older adults. The median age was 77.3 years. A significant proportion of participants lived in multifamily housing (52.6%) or alone (71.1%). Most participants had positive health characteristics: They were not frail (63.2%), reported good subjective health (84.2%), and did not experience depression that significantly affected their daily lives (86.8%; Table 1).

Conceptual Framework

Through selective coding, a conceptual framework was constructed comprising three core categories explaining the perceptions, experiences, and behaviors of walking among older adults in the contexts of both urban living and aging (Figure 2). These core categories exhibited a circular structure, with the two contexts linked to the backgrounds that shaped interactions with older adults and the environment through active walking. Supplementary Table 2 highlights specific examples related to the major categories and contexts within the conceptual framework, through quoted excerpts.

Core Category 1. The attributes of walking perceptions among older urban adults

• 1) Embodied subjectivity as healthy older adults

For the study participants, walking was a means to experience a sense of personal control, cultivate a healthy self-image, and showcase their status as healthy older adults to others. These distinctive attributes were relevant to the increasing significance of walking in later life, which became more pronounced as the participants aged.

• 2) Autonomy of movement

The study participants experienced movement autonomy through the practice of walking, which required them to independently move their bodies rather than using their cars or other modes of transportation. Daily life centered around walking provided the freedom to explore and interact directly with local communities and spaces, allowing their feet to take them wherever they wanted. This freedom of movement and face-to-face encounters provided a universal quality inherent to the act of walking.

• 3) Walking as a way to enrich or sustain life

The daily lives of the participants unfolded in different ways depending on their purpose for walking. It enabled them to engage with the community and provided opportunities to directly enjoy the atmosphere and places within the neighborhood. Furthermore, while navigating the neighborhood, they naturally encountered their neighbors, making walking a form of social interaction. Moreover, walking for exercise and recreation brought a sense of accomplishment and satisfaction as they spent their time in a meaningful and diligent way. It also served as a way to validate their healthy aging.

For economically disadvantaged study participants who had to collect recyclables throughout the day, walking served as an economic activity and a means of livelihood. Owing to career interruptions and a lack of job skills, these participants relied on public service jobs such as picking up trash on foot or collecting recyclable materials in the neighborhood all day.

Core Category 2. The frequent and meaningful interaction between older adults and the environment through active walking

• 1) Natural social interaction among older adults in the community

Within the neighborhood, there were shared public spaces and walking routes, leading to situations in which participants encountered each other several times per day. Consequently, they naturally shared information about their daily lives, making it easy for most participants to anticipate the activities of other older adults in the community.

By interacting with each other, the participants found that several older adults living in similar situations lived in the same neighborhood. This social homogeneity helped them build a sense of community. Additionally, by forming a sense of community, a virtuous cycle was created to increase the frequency of going out by motivating participants to actively participate in social activities.

• 2) Person-place interaction in the community

The study participants had ample opportunities to perceive their neighborhood environment through active walking in the community. The attributes of the perceived environment, derived from the interviews, were safety, accessibility, familiarity, pleasantness, and aesthetics. Additionally, frequent community walking played a mediating role in promoting participants’ adaptation to the neighborhood environment. Exploring various neighborhood spaces on foot increased the participants’ sense of control over the environment and expanded their living space; it also created a set of unspoken rules and conventions for older people using community spaces, such as hours of availability and gender-specific use of spaces that would be unknown to outsiders.

Core Category 3. The multidimensional health benefits of active walking in older adults

• 1) Individual-level health-promoting effects

Active walking strengthened the belief of the study participants that they were able to lead a healthy life on their own and engage in daily activities, which increased their emotional stability. They were satisfied that, as members of the local community, they were able to participate in social activities when they wanted and were free to go where they wanted, which was important for maintaining self-esteem as they aged. Moreover, several participants found that regular walking helped relieve everyday stress, leading to emotional stability and a sense of balance.

• 2) Community-level health-promoting effects

Active walking by the study participants enhanced their sense of place and community within the local community. Through walking, the study participants expanded their experiences with community facilities and spaces, causing them to attribute meaning to these places through subjective environmental perceptions. These experiences led to a deeper understanding of their neighborhood, which over time, translated into a sense of belonging and attachment to the community. Moreover, social interactions between the study participants and other community members facilitated understanding and communication about community issues, creating opportunities for them to form empathic connections. Additionally, as active older adults became more visible in the local community, taking advantage of opportunities to voice their opinions on community issues whenever such opportunities arose, a natural atmosphere of active interest and participation by older adults in the local community was fostered.

Active walking by older adults in the local community serves as an informal social safety net. During the COVID-19 pandemic, public services and facilities were disrupted, leading to a breakdown in the service delivery system. However, the informal social safety net of active walking practices among older adults complemented the formal services in the study area. Several participants naturally checked on and cared for each other during their regular walks. Additionally, independent older adults who could walk volunteered to provide direct assistance to economically and physically vulnerable older members of the community, stepping in to provide material support that was previously provided by public service providers.

Context 1. A life in old age reconfigured around walking

• 1) Restricting daily life to the neighborhood as they age

For most study participants, the decline in economic activity and physical function in later life reduced the need to travel long distances outside the neighborhood or to drive. Moreover, the participants spent most of their daily lives in the neighborhood because of a decrease in opportunities for friendships and interactions outside the neighborhood. Mobile GPS measurements showed that the average life space of the study participants was a radius of 513 m from their home and that they typically walked 15 min each way (Figure 3).

• 2) Increasing the significance of walking in later life

The study participants experienced a decline in physical ability as a result of aging; hence, as they became more focused on health management, the importance and role of walking in their lives increased. They overwhelmingly felt that they officially entered old age around age 75, when their healthcare needs began to increase. This shift in perception coincided with increased awareness of the importance of health management, underscoring the central role of walking in their overall well-being. They felt threatened by the idea that walking might no longer be a natural activity as they aged and perceived older people who walked actively as ideal models of successful aging. Regular walking became a necessary health maintenance activity and a self-set goal and meaningful commitment. Additionally, the participants expressed positive attitudes toward walking, viewing it as an enjoyable, fun, and invigorating activity that brought vitality to life. They also saw walking as a free way to move around and reduce stress, and as a beneficial form of exercise.

Context 2. Two facets of urban environments related to walking in older adults

• 1) Diverse and dense environments within walking distance

With their dense clustering of essential daily destinations within walking distance, neighborhood facilities play a role in promoting walking frequency among older urban adults. Through field observations, the study area had a high density of neighborhood living facilities, including 10 social welfare facilities, 55 commercial facilities, 12 medical facilities, 19 religious facilities, 9 local parks, 1 subway station, and 12 bus stops within a 0.55 km² area (Supplementary Figure 1). This suggests that the environment of the study area, where destinations related to the daily lives of older people were densely concentrated within walkable distances, may have had a positive effect on increasing the walking frequency of the study participants.

However, notably, the characteristics of dense environments could sometimes be complicated, congested, and poorly managed, particularly impeding the walking of physically vulnerable older adults. Study participants who were physically frail or had a history of falls tended to avoid walking on the busiest and most densely populated boulevards. They also expressed concerns about the risk of falling and the potential for COVID-19 transmission on crowded streets without designated sidewalks.

• 2) Easy access to local community services

Before the COVID-19 pandemic, local community services for older adults in the study area supported several daily activities at almost no cost, including laundry, exercise, meals, and recreation, in multiple locations in the neighborhood. These services provided regular opportunities for older people to get out and about and played a crucial role in supporting essential daily activities, thereby encouraging walking practices. Particularly, the meal support service, which provided free lunches on weekdays, had a strong impact on encouraging participants’ regular walking practices and establishing daily consistent rhythms.

However, due to space and budget constraints, the demand for services was not met during our data collection period. Fearing that services would become scarce, local older adults clung to them, creating a competitive climate and deepening disparities between certain groups, such as physically challenged older adults who found it difficult to access services regularly. During the COVID-19 pandemic, local community services that would have forced older people vulnerable to infection to congregate were the first to be suspended under social distancing measures. Most local community services in the study area were suspended, disrupting daily routines and significantly reducing opportunities for regular walking. Particularly, those who lived alone and were physically frail were isolated at home without the attention or support of the public administration.

Discussion and Implications

This study used a grounded theory approach to generate a conceptual framework explaining the walking perceptions, experiences, and behaviors of older urban adults from a health promotion perspective. Our findings hold academic significance as they specifically illuminate the multidimensional health-promoting implications of active walking in the later stages of life, moving beyond the medical perspective supported by the geriatric models, which focus on walking primarily as a means of preventing pathological aging (Middleton et al., 2010).

The subjectivity of being a healthy older adult and autonomy of movement was central to the participants’ daily walking perceptions. Goins et al. (2015) highlighted how walking allowed older adults to actively participate in their community, showcasing their vitality. Similarly, in our study, participants felt in control of their lives while exploring the community through walking. For them, walking was not just physical activity; it was deeply tied to the core concept of humanity. Integrating this insight into targeted health communication may enhance older adults’ perception of walking, effectively boosting walking promotion efforts.

The participants engaged in various daily activities based on their walking purposes. Retirement often triggers feelings of inadequacy and aimlessness (Sekhri & Sekhri, 2017). Our study highlights the significance of maintaining a range of life activities and actively engaging in meaningful pursuits to adapt successfully to retirement. Meanwhile, a remarkable phenomenon emerged among the study participants who engaged in recyclable collection: walking itself became a job. As of 2017, 66,000 older adults in Korea were engaged in waste paper collection to earn a living (Byeon et al., 2018). In other words, some of the older urban adults who engage in walking are doing so not by choice, but out of necessity for their livelihoods. Therefore, it is essential to discuss strategies for promoting various life activities through the act of walking in the daily lives of older adults within age-friendly city plans and to consider how to address the needs of older adults who walk for employment purposes.

The social interactions of the study participants due to walking increased their interest and participation in the community and their sense of belonging to the neighborhood. A sense of community has a reciprocal relationship with community participation (Prati et al., 2016). This suggests that older adults’ walking practices may play a key role in bridging their sense of community and community participation. Therefore, the expansion of community health initiatives that focus on promoting walking among older adults may serve as an important strategy for creating an age-friendly city that strives for social integration.

The person-place interaction between the study participants and their environment through walking shaped their perceptions regarding their neighborhood and increased attachment. Moore (2014) defines place as where actual and everyday activities take place within the realm of life, whereas space is defined as existing outside the realm of life as a background. Furthermore, spaces are transformed into places according to people’s experiences, interactions, and cultural norms. Therefore, older adults experience a process in which spaces that were part of the background of their lives are transformed into meaningful places through walking. Additionally, this increase in meaningful places for older adults in the neighborhood can contribute to increased attachment to the neighborhood, leading to the desired goal of older adult permanence in an age-friendly city. Therefore, it is important that environmental planning for age-friendly neighborhoods and local health plans recognize that the places that older adults experience and discover through walking are valuable community health assets.

Active walking increases self-esteem, self-efficacy, and emotional stability in autonomous and healthy individuals. The relationship between increased physical activity in older adults and improvements in self-esteem and self-efficacy is causal (McAuley et al., 2005). Additionally, the Theory of Planned Behavior proposes that behavior is influenced by intention and that intention is shaped by perceived behavioral control, a concept similar to self-efficacy (Ajzen, 2011). Essentially, there is a cyclical structure of self-esteem, self-efficacy (as a manifestation of well-being), and the intention to walk in the lives of actively walking older adults. Therefore, policy interventions that promote active walking among older adults may have a self-reinforcing effect on walking behavior, leading to sustainable policy outcomes without the need for ongoing large-scale interventions.

In our study area, older adults established informal social networks due to disrupted community services during the COVID-19 pandemic. Although informal care is common in rural areas (Volckaert et al., 2021), our study revealed self-organized care, filling the public care gap created by the COVID-19 pandemic. Owing to the challenges of aging populations and the financial strain on local governments, Asian countries have actively discussed implementing community care, a service centered around community caregiving (Braun & Conybeare, 2017). However, the model of community care, and the capabilities and conditions required by local communities for community care to function, remain vaguely defined (Kang & Choi, 2019). Our findings indicate that communities with active older adults may support community care, underscoring the relationship between age-friendly cities and community support.

The restriction of daily life in the neighborhood as people age due to constraints on economic activities and reduced long-distance travel has been observed in the context of older individuals, primarily focusing on walking. In the process of planning urban development and public services, the mismatch between life-space mobility and administratively defined service areas leads to imbalances in service accessibility and blind spots in policy implementation (Yang et al., 2022; Yoo & Kim, 2017). To create an age-friendly city and ensure the well-being of older residents, it is essential to adjust the spatial units in which services are provided to the geographic areas where older adults primarily spend their daily lives. This approach involves tailoring local policies, transportation systems, and community resources to meet the needs of aging populations in their immediate neighborhoods. By addressing the concept of life-space mobility comprehensively (Webber et al., 2010), policy-makers can better design interventions and services that cater to the diverse mobility requirements of older adults, promoting independence, social engagement, and overall well-being.

In this study, walking was found to play an increasingly significant role in people’s lives as they aged. The emotional changes associated with aging have been elucidated through the concept of emotional optimization (Lawton et al., 1992). According to this concept, older people actively and positively engage in efforts to maintain their subjective well-being by deliberately selecting situations that provide positive stimuli to avoid negative emotional experiences associated with the aging process. Our study also suggests that walking becomes a behavior intertwined with emotionally meaningful goals for individuals at this stage of life, illustrating their proactive efforts to maintain their quality of life. Therefore, it is recommended that future studies on walking among older populations consider it not only as a behavior but also as a multifaceted action imbued with emotional meaning and value.

Concentrating various destinations and accessible community services within walking distance of older people resulted in an urban context that encouraged frequent walking among our study participants. In response to the challenges of economic stability, livability, and emissions reduction, the concept of the 15-min city is at the forefront of urban planning discussions (Moreno et al., 2021). This concept calls for a new topology in which the city must be structured so that residents can access basic services within a 15-min walk or bike ride (Allam et al., 2022). In Ottawa, Canada, the idea of 15-min cities has been introduced as a means to achieve the Five Big Moves vision for a healthier lifestyle. To implement this concept, priority is given to nine key amenities to make cities more adaptable and space efficient. This approach enables older adults to walk comfortably, anytime and anywhere. Alternatively, it has been argued that dense and disorganized urban development can lead to problems such as traffic congestion, inequality of opportunity, social fatigue, risk of falls, and spread of infectious diseases (Casarin et al., 2023; Plaut et al., 2021). Therefore, it is crucial to evaluate and monitor compact urban development policies through a health equity lens to ensure that vulnerable older adults are not marginalized.

This study has several limitations and implications. The findings of this study emphasize the salutogenic aspects of walking and focus on active older adults living in pedestrian-friendly urban communities. Therefore, it may have limited applicability to the walking patterns of older adults living in rural or small- to medium-sized cities, where challenges such as longer distances to amenities and lack of public transportation are more prevalent. Future research should encompass diverse communities and environments, as well as a broader spectrum of older adults. Additionally, as this study was conducted during the COVID-19 pandemic, interpretations should consider the pandemic’s impact. Subsequent research should address the post-pandemic landscape. Recent national health data and community-based studies in Korea have shown a recovery in walking activity among older urban adults after the pandemic (Korea Centers for Disease Control and Prevention, 2023; Korea Health and Social Research Institute, 2023; Lee, Moon, & Lee, 2023) suggesting a shift in attitudes toward active living among older adults.

Despite its limitations, this conceptual framework explains how walking shapes the daily lives of older urban adults in Seoul and promotes multidimensional health effects. It goes beyond viewing walking as mere exercise, illustrating its role in fostering community engagement, social connections, and overall well-being among older adults. The findings highlight the importance of walking in promoting health and vitality, emphasizing the need for walkable urban environments in urban planning and community design. Understanding the relationship between older adults and their urban settings is crucial for developing age-friendly cities and promoting healthy aging. Thus, this study offers valuable insights into the significance of walking for active and healthy aging in urban contexts, advocating for walkability and community engagement among older populations.

Supplementary Material

Supplementary data are available at The Gerontologist online.

Funding

This work was partially supported by the Health Fellowship Foundation (HFF-2019).

Conflict of Interest

None.

Data Availability

The data are not available to other researchers for replication due to ethical restrictions, and the study reported in the manuscript was not pre-registered.

Author Contributions

Dong Ha Kim (Conceptualization [Lead], Data curation [Lead], Formal analysis [Lead], Funding acquisition [Supporting], Investigation [Lead], Methodology [Equal], Project administration [Supporting], Resources [Supporting], Software [Lead], Supervision [Supporting], Validation [Equal], Visualization [Lead], Writing—original draft [Lead], Writing—review & editing [Supporting]); Seunghyun Yoo (Conceptualization [Supporting], Data curation [Supporting], Formal analysis [Supporting], Funding acquisition [Lead], Investigation [Supporting], Methodology [Equal], Project administration [Lead], Resources [Lead], Software [Supporting], Supervision [Lead], Validation [Equal], Visualization [Supporting], Writing – original draft [Supporting], Writing—review & editing [Lead])

References