“It Made Me Change the Way I Do Business”: Outcomes From Age-Friendly Community Initiatives as Systems Change

Abstract

Background and Objectives

Since the early 2000s, a global age-friendly communities (AFC) movement has called for improving the built, social, and service environments of localities for aging. Yet research on the outcomes of AFC initiatives, as programmatic efforts toward AFC progress, remains in its nascence. Drawing on “The Water of Systems Change” framework, our study aimed to address this gap by exploring the extent to which accomplishments of AFC initiatives are indicative of altering six conditions for systems change: policies, organizational practices, resource allocations, power dynamics, relationships, and mental models.

Research Design and Methods

We analyzed qualitative data from 26 key informant interviews across eight mature AFC initiatives in the northeastern United States (U.S.). We engaged in iterative phases of thematic analysis to explore how the initiatives’ accomplishments, as described by the participants, align with each of six focal conditions for systems change.

Results

We found especially robust and consistent evidence for outcomes in terms of enhanced organizational practices on aging; resource flows; connections within and across communities; and mental models about older adults. Evidence for outcomes concerning changes in power dynamics and policy was more limited.

Discussion and Implications

Conceptualizing AFC initiatives as systems-change interventions can bolster research, evaluation, and program development as the movement proliferates and diversifies into the 21st century. Insights can help to advance praxis that empowers AFC leaders as changemakers for “successful aging” at the level of society.

A global age-friendly communities (AFC) movement aims to catalyze, support, and sustain the efforts of community leaders to make their localities more inclusive of older residents and supportive of healthy aging (World Health Organization [WHO], 2007). Such efforts are congruent with 21st-century discourse on “successful aging,” which calls for explicit attention to population aging at the societal level. Building on Matilda White Riley’s concept of structural lag (Riley & Riley, 1994), Rowe and Kahn (2015) call for “rigorous and inventive research to test the success of new policies and structures” aimed to optimize older adults’ biological, psychological, and social well-being (p. 595).

Age-friendly communities initiatives, as programmatic efforts to systematically improve the age-friendliness of localities, constitute one such “new” structure of the 21st century. Despite a growing body of research on AFC implementation and development, research on their outcomes remains limited (Forsyth & Lyu, 2023). Scholars have noted various challenges for empirically demonstrating their effectiveness, including multifaceted and heterogeneous practices across initiatives and the diversity of ways to operationalize their outcomes (Hong et al., 2023; Rémillard-Boilard et al., 2021).

Our study aims to contribute to a growing literature on the outcomes of AFC initiatives by advancing theoretical understanding of the potential yield of these efforts in terms of systems change. Systems change broadly refers to altering the conditions that “hold a problem in place” (Kania et al., 2018). Consistent with theorizing on successful aging at the societal level (Rowe & Kahn, 2015), our study is premised on the idea that optimizing social, built, and service environments of communities for aging constitutes a fundamental social issue. We explore ways in which AFC leaders’ narratives on the work of their initiatives conceptually link with changing the systems conditions that hold this issue in place. More specifically, we draw on the “Water of Systems Change” framework, as formulated by Kania and colleagues (2018), to explore how AFC initiatives’ accomplishments align with each of six conditions for systems change, including altered policies, organizational practices, resource allocations, power dynamics, relationships, and mental models.

Background on AFC Initiatives and Their Outcomes

The global AFC movement, as initiated and organized by the WHO, calls on leaders of cities and other jurisdictionally based places to improve the age inclusivity of their communities. In 2010, the WHO accelerated the development of AFC initiatives by organizing the Global Network of Age-Friendly Cities and Communities (Rémillard-Boilard et al., 2021) with corresponding domestic networks among national affiliates (WHO, 2018). Currently, such networks encourage members—typically local or subnational governments—to improve the age-friendliness of their jurisdictions by following a social planning model. This model includes collaborative activities that occur across phases: initiating a multisectoral committee (including older residents) to oversee the initiative and gather community assessment data, developing action plans for AFC improvements, implementing actions, and evaluating, monitoring, and reporting on implementation to guide subsequent planning and action (WHO, 2018).

Fitting with a social planning model, AFC discourse generally has framed community outcomes based on a deductive approach in which AFC outcomes are positioned as empirically derived indicators of community age-friendliness. Such outcomes include the presence, accessibility, and affordability of public spaces and transportation systems, housing, social, and health services, as well as neighborhood walkability, social attitudes toward older adults, later-life paid employment/volunteer options, and social/political engagement opportunities (Aung et al., 2021; Lee & Kim, 2020; WHO, 2015). According to the WHO (2015)—and recognized by researchers as well (e.g., Kim et al., 2022)—such indicators of community age-friendliness “should be an integral part of an outcomes-oriented accountability system for [AFC] initiatives” (p. 5).

A complementary body of literature has advanced a more inductive approach. This literature explores the processes of, and contexts for, implementing AFC initiatives, and as a result, has implicated a conceptual range of AFC outcomes that draw from the accomplishments of AFC initiatives in actual practice. Collectively, these studies have documented outcomes such as alterations in social connections and relationships (Black & Oh, 2022; Greenfield, 2018; Rémillard-Boilard et al., 2021; Russell et al., 2021, 2022), altered policies and plans (Forsyth & Lyu, 2023; Russell et al., 2022), changing views and attitudes toward aging (Coyle et al., 2022; Forsyth & Lyu, 2023; Greenfield, 2018; Rémillard-Boilard et al., 2021), and the fortification and sustainability of the AFC initiative itself (Forsyth & Lyu, 2023; Rémillard-Boilard et al., 2021). This literature has further identified important types of outcomes that AFC initiatives might struggle to achieve, such as large-scale projects, especially concerning the built environment (Forsyth & Lyu, 2023; Rémillard-Boilard et al., 2021; Russell et al., 2021), community-wide reach (Colibaba et al., 2020), population health outcomes (Forsyth & Lyu, 2023), and programmatic outcomes of stable human and financial capacity (Russell et al., 2021, 2022). To our knowledge, only one paper has directly discussed AFC outcomes in terms of systems change. Coyle and colleagues (2022) draw on diffusion-of-innovation theory and use a systems perspective to understand the spread or adoption of change (e.g., practices, attitudes, and interventions) throughout networks, drawing on experiences from Age-Friendly Boston more than five years into its work on age-friendly goals.

Orienting to Systems Change

Adopting an inductive orientation to studying AFC outcomes in actual practice, our study seeks to advance understanding of the potential systems-level outcomes of AFC initiatives. We do so by situating the accomplishments of AFC initiatives, as described by practice leaders, within an existing framework of systems change. “The Water of Systems Change” framework developed by Kania and colleagues (2018) explicates systems conditions surrounding entrenched social issues. Systems conditions are contexts that can facilitate or impede social transformation (Kania et al., 2018). Like fish who do not understand the life-sustaining importance of their surrounding waters, this framework holds that social actors are in many ways similarly unaware of the centrality of systems conditions in which they operate.

We premise our exploration of potential alterations of systems conditions on the idea that improving communities for population aging is a complex issue that cannot be addressed “through the implementation of individual programs organized by a single nonprofit organization or community agency (but) instead…must be addressed through the engagement of multiple community stakeholders” (Lawlor & Neal, 2016, p. 426). Accordingly, our study is premised on the idea that fully accounting for the yield, outcomes, and impact of AFC initiatives should similarly be explored beyond the scope of a single initiative to include potential alterations in conditions toward social transformation.

Integrating across earlier theorizing on systems change (e.g., Foster-Fishman & Watson, 2012), “The Water of Systems Change” framework describes systems conditions in terms of six key theoretical constructs (Kania et al., 2018). Policies, practices, and resource flows—as three constructs encompassing structural change—are theorized as the most readily visible. Relationships and connections, as well as power dynamics, encompass relational change and are semi-explicit. Mental models, as transformative change, are the most implicit. The framework organizes these three levels as an inverted pyramid (refer to Figure 1, including definitions of each condition), with the idea that conditions at the structural level are held in place by conditions at the relational level, which are further undergirded by mental models.

Focus of the Study

Our study begins to extend a systems-change orientation to the study of AFC initiatives by exploring the relevance of the above-listed six theoretical constructs for conceptualizing their outcomes. Specifically, we probe the ways in which they are congruent with how practice leaders describe the accomplishments of these initiatives. Our focal research question is: In what ways do the accomplishments of AFC initiatives reflect shifts in conditions for systems change, encompassing altered policies, organizational practices, resource allocations, power dynamics, relationships, and mental models? In employing new language and awareness to the ubiquitous systems that AFC initiatives both operate within and potentially act upon, we aim to advance the practice and research conceptualization for observing, measuring, and studying the outcomes and impact of AFC initiatives.

Method

Research Design and Setting

We drew on data from qualitative interviews with key informants representing eight mature AFC initiatives in northern New Jersey (U.S.). These initiatives comprised a regional network of AFC under a multiyear grantmaking program of two local philanthropies. The informants included grassroots community residents, professionals within nonprofit organizations, and municipal employees, all who were part of AFC core teams or close partners. Core teams include individuals with primary responsibility for moving the work of an AFC initiative forward in a community on a regular basis. (Refer to Data Collection and Sample for more information.) Since the launch of the grantmaking program that seeded these initiatives starting in 2016, the research team conducted multiple waves of interviews with leaders of each initiative to understand their development, sustainability, and outcomes. For the current study, we drew on data from the most recent round of interviews (February through June of 2023), constituting the longest possible time course for studying the initiatives’ long-term outcomes and perceived impact. For more information about the design of the parent project as a developmental evaluation, refer to Greenfield et al. (2022).

Data Collection and Sample

The following people were deemed eligible for participation as key informants: current core team leaders, prior core team leaders, as well as prominent partners and leaders of the initiatives’ auspice organizations. Drawing on our long-term knowledge of the initiatives, we developed a list of eligible individuals for each of the eight initiatives based on these criteria and added several individuals to the sampling frame when identified as key informants by other participants. In total, we invited 28 individuals to participate, of which 26 participated.

Tables 1 and 2 display information regarding the initiatives’ community settings, as well as the participants, respectively. The eight AFC initiatives largely were located in midsized cities in northern New Jersey. Communities ranged in the percentage of residents racialized as White, non-Hispanic (13%–77%, median 53%). The median income of residents in each community spanned $59,939–$211,224 (median $130,080). The majority of the 26 individual participants identified as female (N = 22), White (N = 21), older than 55 years (N = 19), and as current leaders of an AFC initiative at the time of the interviews (N = 16).

All interviews addressed the participants’ perceptions of their initiatives’ long-term impact and sustainability, among other topics (refer to Supplementary Appendix A for sample interview questions). Before each interview, the research team reviewed background information about the initiative, including progress reports and grant applications, when available. We also developed an analytic memo for each initiative based on transcripts from prior group interviews conducted with each of the eight initiative’s core team leaders. We customized questions across interviews according to this background information and also explored different themes in more or less depth as data collection progressed within each community.

Interviews took place by Zoom and were approximately 60 min. All interviews were audio-recorded, transcribed, and entered into software for qualitative data analysis (Dedoose). Participation in the study was voluntary, and the study received approval from the Rutgers University Human Subjects Board.

Data Analysis

Our analysis spanned an emergent two-phase process comprising an initial inductive orientation to the outcomes of AFC practice followed by a deductive phase aimed at illuminating underlying systems-change alterations. Using thematic analysis, we began a first phase of analysis by reading each transcript in its entirety and excerpting segments regarding the AFC initiatives’ accomplishments. We then conducted two iterative rounds of coding with blends of structural coding and focused coding to identify and clarify the conceptual contours of AFC accomplishments. Structural coding is a first-cycle coding approach that is well-suited for categorizing data in exploratory investigations based on semistructured interview data, whereas focused coding is a second-cycle coding method to develop and crystallize the most salient conceptual categories (Saldaña, 2021). Refer to Greenfield et al. (2023) for a full discussion of the thematic categories of outcomes identified through this first analytic phase.

Our prolonged engagement with the data led us to a second phase exploring AFC outcomes from a higher-order theoretical aperture on how the previously identified accomplishments reflected shifts in systems conditions. Accordingly, our coding was guided by a priori codes regarding the six conditions for systems change. Echoing the structure of the first coding phase, the data were recoded using structural coding oriented to the six conditions. In the subsequent iteration, we again used focused coding to deepen the conceptual meanings of the coding from the prior iteration, especially by using subcoding to probe for patterns of meaning within each of the codes. Supplementary Appendix B presents the evolution of the codes generated and employed across the multiple iterations of coding.

Across all phases of analysis, we extensively used memo writing to develop the code definitions and their manifestations across the communities. During the second phase, we also used matrices across codes to develop the results. This technique allowed us to clarify points of similarity and difference across passages that addressed multiple and, in some cases, conceptually related categories (e.g., policy and power). We also used memo writing to compare and contrast communities more holistically about the extent of evidence for their influencing conditions for systems change, which further advanced the conceptual clarity of our codes. We also maintained an audit trail of methodological decision points and coding/thematic development to enhance trustworthiness, dependability, and transparency. We further engaged in peer debriefing throughout the analysis to discuss the emerging analysis, refine the conceptual clarity of the codes, and move the analysis toward deeper interpretation. Finally, we conducted a member check through which we shared a draft of the findings with all individuals who participated in the study and invited their feedback. All participants who provided feedback stated that the results were reflective of their practice.

Results

Overall, participants’ narratives were replete with examples of how their initiatives led to activities, outputs, outcomes, and perceived impact related to many of the six conditions of systems change. Although we present results below under discrete thematic categories, there were many instances in which participants described shifts in one condition as being interconnected with changes in others. (For an example, refer to Supplementary Appendix C, Exhibit A.) Below we present findings with respect to each of the six systems conditions, beginning with the four conditions that were especially prevalent across the interviews (practices, resource allocations, relationships, and mental models), followed by two conditions for which the evidence was more limited (policy and power). Table 3 displays a summary of results.

Practices

Practices refer to the “espoused activities” of entities focused on social and environmental progress, as well as “the procedures, guidelines, or informal shared habits” related to this work (Kania et al., 2018, p. 4). Participants’ narratives indicated two ways in which the initiatives influenced the practices of other organizations and groups within their communities: (a) amplifying programs and services for older adults, and (b) engendering stronger norms for collaborative practice on aging.

First, participants described how they influenced the practices of a great variety of local community organizations and groups, including the auspice organizations in which the initiatives were embedded, municipal departments, government instrumentalities (e.g., local libraries and older adult [“senior”] centers), nonprofit organizations, housing communities, and, in a few cases, healthcare organizations. (For an example of such diversity in influence, refer to Supplementary Appendix C, Exhibit B.) The initiatives helped to start up aging-focused programming within organizations that previously offered little to no services explicitly for older adults. It also entailed the adoption and improvement of programs and services within community organizations already conducting work on aging. For example, one participant described their influence on the practices of a local nonprofit organization on housing assistance, stating: “I think as it becomes more obvious that they have older people who need help, they do more with older women intentionally now, either people who are displaced homemakers or shared housing” (community [C] 7, participant [P] 1).

Second, participants reflected on how their initiatives strengthened norms for collaborative practice on aging, encouraging service providers to view their work and their clients as part of a larger community network. An interview with a leader of a housing authority, who served as a key partner for one of the initiatives, spoke directly about such practice change. She recounted how her organization started regularly partnering with outside entities to offer more robust programming for older residents after they began partnering on programs with the AFC core team. The initiative further “inspired” them to reach out to the local university to have student interns lead programs for older residents, which grew over time from having “simply one intern” to ongoing and multiple collaborative, grant-funded projects. The participant reflected: “It made me change the way I do business…Instead of doing these one-off type of programs, I’m trying to build within the housing structure ongoing programs that hopefully make a difference in the way people live” (C2.P4).

Resource Flows

Resource flows refer to how financial, human, informational, and “other assets are allocated and distributed” (Kania et al., 2018, p. 4). We found two main ways in which the AFC initiatives’ accomplishments demonstrated altered resource flows: first, with respect to resources concerning local built and service environments; and second, enhancing the flow of information within communities.

First, the AFC initiatives encouraged investments in improving various components of their communities’ built environments, such as the repair of sidewalks, the installation of new benches, improvements to municipal parks, additional signage at key intersections, and, in one case of a nonprofit-based initiative, the construction of new affordable housing for older adults on donated municipal land. Regarding their services environments, a focal accomplishment of many of the initiatives was the establishment of new positions for social service professionals to work directly with older adults. Six of the eight initiatives described how their work led to such new positions. These new positions were created either within the local administration or at community-based organizations. Participants described how altering resource allocation toward these changes was not entirely, or in many cases, at all, within their own control; rather, they described a process of indirectly altering resources within the scope of another organization. In many cases, this work involved collaborating with other community leaders to bring in external resources, including funding from an Area Agency on Aging, COVID-related relief funds, AARP Challenge grants, and regional public health grants.

Flow of information was the second primary way in which participants described altered resource flows. Newsletters, social media accounts, and resource guides resulting from the AFC initiatives helped to provide information—emanating both from within and outside of the community—to support residents as they age. In some cases, communications platforms were developed and maintained by the AFC initiative itself. In other cases, they were embedded within the communication tools of other community organizations. For example, one municipally-based participant described how the newsletter of a local Recreation Department “is now being built up to be bigger and be more encompassing than just, here’s the schedule of events” (C8.P1). Participants further described how their initiatives helped to bring information from residents to community decisionmakers, both within the municipality and at higher systems levels. Another municipally based participant, for example, described herself as the liaison between older residents and the municipal administration on concerns regarding the built environment, such as street safety.

Relationships

Relationships and connections encompass the “quality of connections and communication occurring among actors in the system, especially among those with differing histories and viewpoints” (Kania et al., 2018, p. 4). Participants’ narratives were rich with examples of how their efforts strengthened relational connections both within the community, as well as across communities. (Refer to Supplementary Appendix C, Exhibit C, for a quote from a community leader reflecting on how relationship-building is a focal point of their work.) Our analysis indicated three primary types of connections that the AFC initiatives enhanced: (a) connections among organizational and other leaders within the community, (b) connections among age-friendly leaders from different communities, and (c) connections among older residents and key community decisionmakers.

Regarding the first subtheme, participants described many instances of how their initiative helped to strengthen connections across a variety of organizational and other community leaders by facilitating collaborative action toward age-friendly goals. For example, a participant—who was new to the position of AFC coordinator as part of a municipally based initiative—described the ease by which she was able to engage leaders of other community organizations to present at an annual volunteer fair by building on the relationships established in prior years of organizing the fair. In addition, many participants reflected on how the AFC initiative helped to establish new interorganizational groups for convening community leaders on aging. For example, a participant from the nonprofit sector, who was a key partner of one of the AFC initiatives, reflected on the value of the initiative convening regular meetings among organizations conducting work on aging: “I think part of what was a huge benefit of [the initiative] is that it brought all those voices to the table” (C5.P3).

The second subtheme addressed new and stronger connections across networks outside of the focal community, including deeper connections between higher- and lower-systems levels (e.g., county and municipal), as well as across age-friendly community leaders in the region. For example, spurred, in part, through their experiences of leading AFC efforts at the community level, AFC leaders from several communities initiated monthly networking meetings for aging service providers in their region. Others commented on how their involvement with AFC efforts at the local level initiated or amplified their involvement on county boards and committees with relevance to aging. Participants also described the significance of forging relationships with other AFC leaders through a regional alliance that emerged as part of the multiyear grantmaking program that seeded the initiatives. For example, a nonprofit partner of one of the initiatives reflected on the benefits of building connections with other initiatives: “I’ve been able to tap into not only the resources and not only the networking and people who work in other agencies that are in the alliance, but just hearing what they’re doing. I’ve been able to incorporate that in my space here at [name of organization]” (C7.P2).

The third subtheme regarding relationships addressed the initiatives’ work to forge stronger connections between older residents and key community actors. Several participants recalled how individuals in need would reach out to them, with whom they would then connect with specific community service providers. One community from the nonprofit sector, in particular, was leading the development of a new community center strategically located in a historically underserved and racially marginalized neighborhood, at which their initiative’s auspice organization would offer programs and services: “We haven’t made as many connections with the residents of [that neighborhood] that we would like to make. We are hoping that when we’re neighbors, that will help… Really, it’s going to be a visible thing, a street-level building with a sign out front that people will see, and it’s going to make a big difference” (C1.P4).

Mental Models

Mental models refer to “habits of thought—deeply held beliefs and assumptions and taken-for-granted ways of operating that influence how we think, what we do, and how we talk” (Kania et al., 2018, p. 4). Participants’ narratives addressed how their initiatives served to shift mental models, especially among community decisionmakers, in two primary respects: (a) enhancing the visibility of older adults and the importance of local services, and (b) viewing the AFC initiatives and local community-based organizations as a resource.

First, participants described how their work helped community leaders become more aware of older adults as a distinct population subgroup that can benefit from local programs and services. Collectively, the participants identified leaders across a variety of community organizations, including library directors, staff of regional social services, and officials within municipal departments (e.g., police, health, and recreation). One participant based in the nonprofit sector, for example, recalled how years ago, they had approached elected officials, encouraging them to “hire somebody part-time to be an age-friendly person to work for the (town) to take care of the needs of the older residents and all of this.” Nothing happened until “COVID happened, and they realized seniors weren’t getting vaccinated…People were dying, and I think that was when they realized we’re trying to take care of what’s really a critical need relying on volunteers” (C8.P2). Shortly thereafter, the local administration created a new position for an older adult services program manager.

Second, participants described changing mental models with respect to how their own community-based organizations and initiatives can serve as a resource to community leaders on aging. One participant, in particular, described how the initiative changed people’s understanding of what their nonprofit organization can offer. Prior to the initiative, they were known primarily as a physical location providing care for older adults. Years later, the participant reflects: “I’m not just like a service provider in the community or a business owner. I think it’s opened their eyes” (C1.P1). Another participant also based in the nonprofit sector described the importance of a “shift” in “attitude” among elected officials regarding their understanding of what age-friendly means: “So that if somebody says, ‘Do you know what age friendly is?’ There at least is some recognition on their face, ‘I’ve heard of that. I know what that is, or I want to know more’” (C8 P2).

Policy

Although not entirely absent, there was relatively less evidence of how the AFC initiatives influenced policy—as “government, institutional and organizational rules, regulations, and priorities that guide the entity’s own and others’ actions” (Kania et al., 2018, p. 4). Subthemes included advocacy on the passage of local policies (e.g., embedding of age-friendly language within municipal master plans on land-use, which was achieved by an initiative led through the public sector) and better implementation of existing policies (e.g., holding business owners responsible for attending to broken sidewalks on their property when residents voiced complaints—an accomplishment of an initiative that was grassroots-led). Some participants, however, reflected on ways in which their efforts to influence policy did not result in desired changes. For example, one participant from the nonprofit sector reflected on their initiative’s long-term advocacy on the use of a municipal van to provide rides for community residents to access the older adult center of another community; however, local officials were not pursuing this change because of “contractual issues” (C5.P4). Another participant operating as a grassroots community leader reflected on how County officials were making public proclamations regarding their commitment to AFC, but had very little evidence to show for it, stating: “It’s been very frustrating” (C7.P1).

Power

Power dynamics address the “distribution of decision-making power, authority, and both formal and informal influence among individuals and organizations” (Kania et al., 2018, p. 4). Again, we found some, but more limited evidence of shifts in power dynamics. The evidence that we did find emerged largely with respect to the degree of influence from advocates outside of local government—principally the AFC initiative leaders themselves—on actors within the municipal administration.

One initiative based in the nonprofit sector, in particular, reflected on how they were successful in positioning themselves over years of implementing their initiative as a trusted resource on aging to their municipal administration. They described how, early on, they were the ones to regularly initiate communication and request meetings with local officials. Now, at the time of the interviews, participants described ways in which the municipal administration was consulting them, such as by asking for their input on aging-related grant proposals, placing information about the initiative on the municipal website, offering facility space for the initiative to connect with community members, and collaborating with the initiative on a new affordable older adult housing project.

Two additional initiatives reflected on their success at influencing power dynamics concerning aging in community by supporting the development of municipal committees on aging. For one initiative based in the nonprofit sector, this committee was introduced new to the municipal administration because of the AFC initiative, and in the other case, also based in the nonprofit sector, the AFC initiative helped local officials to restart the committee after decades of inactivity. In both cases, the membership of the committees centered on older adult residents, whose role was to advocate to local administration on issues of importance to them. One participant, who was formally involved with an initiative in the nonprofit sector, described this new structure as an effective way to influence local officials: “I think seniors have more say in town through the (committee), and they do let their feelings known. That is better than what it used to be… Any issues that they see, they bring it up, and it gets worked on” (C5.P2).

In other instances, however, participants reflected on continued barriers to effectively influencing municipal administration. One initiative operating through grassroots community leadership, in particular, described how frequent turnover among local officials, as well as sheer refusal to listen to age-friendly advocates, created challenges for developing a stable and constructive relationship with the local council and administration. Another participant from the nonprofit sector, however, stated that even if their influence on the municipal administration remained limited, they still took pride in the other ways they were making a difference in their communities. For examples, refer to Supplementary Appendix C, Exhibits D and E, respectively.

Discussion

We applied a systems-change perspective to explore the outcomes of AFC initiatives based on qualitative interviews with practice leaders, drawing on the six focal conditions for systems change (Kania et al., 2018). Our findings demonstrate how programmatic outcomes of AFC initiatives—such as the formation of multisectoral coalitions, the altered practices and resource allocations of other organizations, and greater awareness of the role of localities in supporting residents as they age—can be broadly theorized as altering conditions for systems change. Notably, overall, the practice leaders themselves did not describe their work by using systems-change language. However, as our findings indicate, their reflections on the accomplishments of their initiatives were, in many ways, richly congruent with many of conditions for systems change. The implicit nature of this connection between practice and theory is consistent with the central metaphor of the “Waters of Systems Change” framework (Kania et al., 2018): Although people in their everyday lives might have a sense of the systems in which they operate, there is a need for developing language and greater awareness of how these systems operate to help people grow as agents of social change.

Our findings contribute to a burgeoning body of scholarship to strengthen and pluralize the knowledge base for AFC initiatives toward even greater social impact. Results further emphasize the promise of progressing beyond the long-standing social planning approach that historically has dominated AFC practice guidance (see Yeh et al., 2024, for an overview and critique) toward more relational, network, and systems-oriented praxis. Although prior scholarship has addressed some components of systems change conditions as part of AFC practice (e.g., relationships [Coyle et al., 2022], power [Joy, 2021], policy [Forsyth & Lyu, 2023], mental models and practices [Rémillard-Boilard et al., 2021]), our work explicitly demonstrates the relevance of a framework that allows for a more holistic orientation to multiple and interconnected conditions.

More broadly, this analysis highlights the potential for advancing knowledge of AFC development and implementation through the use of organizational, management, and community psychology frameworks, such as organizational empowerment theory, social network analysis, collective impact, and positive social change framework, among others (e.g., Batras et al., 2014; Greenfield et al., 2022; Lawlor & Neal, 2016). Drawing from these rich fields of academic study could accelerate future research on age-friendly initiatives, especially in terms of generating social innovation and impact.

Relatedly, this framework also has strong potential for advancing AFC program theory. The AFC process discourse has yet to develop a comprehensive theory of change specifying how the actions of implementation are anticipated to produce desired short- and, especially, long-term outcomes (Greenfield & Buffel, 2022; Joy, 2021). Our findings address this gap by offering an initial framework linking incremental outputs and short-term outcomes with deeper social processes of change. For example, our study’s insights encourage a reconceptualization of how a discrete achievement, such as a new partnership, a newsletter, or a community event could be mechanisms for “moving the needle” on deeper currents of systems conditions, such as the durable alteration of organizational practices, systemic flow of information between older adults and community leaders, and new structures for regularly convening community leaders on aging. (For a related discussion, refer to Pope & Greenfield, 2023). Our findings with respect to altering mental models, as another example, demonstrate how AFC initiatives’ communications work at the local level can contribute to longer-term social change on reframing aging (D’Antonio, 2020).

At the same time, it is important to note that our analysis yielded relatively less evidence of how AFC initiatives affect conditions for systems change in terms of policy and power. This aspect of our findings supports the field’s continued exploration of whether concern about paucity of larger-scale and scope outcomes among AFC initiatives (Joy, 2021; Russell et al., 2021) reflects limitations in the AFC program model itself or the field’s ability to conceptualize and detect the most relevant indicators of systems-level effects (Black & Oh, 2022; Greenfield et al., 2015).

Regarding implications for practice, findings support growing attention to understanding and supporting AFC leadership. Multiple reviews of AFC development and implementation have highlighted the importance of strong leadership and governance for the success of AFC initiatives (Forsyth & Lyu, 2023; Menec & Brown, 2022; Torku et al., 2021). Our study’s findings indicate the importance of conceptualizing AFC leaders as systems-change leaders. Senge et al. (2014) describe systems leader as having three core capabilities: capacity to see the larger system (e.g., being able to understand complex issues from multiple perspectives), fostering reflection and productive conversations (e.g., becoming aware of mental models and helping others understand perspectives other than their own), and shifting the collective focus away from responding to problems toward “co-creating the future” (e.g., motivating others to work toward longer-term aspirations and social transformation). Findings from our study implicate the importance of recruiting individuals with such skills into AFC leadership, as well as helping AFC leaders cultivate such skills as their own practice progresses.

Finally, our study helps to expand gerontological praxis on “successful aging” at the level of society. To date, much of the discourse on societal successful aging has emphasized reforms to major federal programs, policies, and large-scale social institutions (Rowe, 2015). Our study’s insights on AFC outcomes as systems change elucidates the importance of recognizing and supporting communities as another “lever” for social change—a level of analysis and action of increasing attention according to a community gerontology perspective (Greenfield et al., 2019). Especially in sociopolitical systems with relatively less centralized control over systems conditions, our findings elucidate the potential for local leaders across diverse sectors to work toward meaningful societal change.

Limitations

Our study was based on AFC initiatives in a particular context—geographically, temporally, and sociopolitically. The extent of evidence for, and manifestations of, alteration of systems condition might differ in other settings. For example, the core teams for most of the eight initiatives were administratively outside of the public sector. Systems change in the context of initiatives more embedded within local government (for discussion, see Pope et al., 2024), especially from their start (Brossoie et al., 2021), might manifest differently. Furthermore, examining the individual, organizational, and community contexts for communities to achieve greater depth and/or breadth in systems change relative to others is outside the scope of this study. Another limitation is that our analysis drew on interview data from AFC core team leaders and key partners without the opportunity to triangulate reports from more distal community actors. Moreover, our analysis was based on the coding of a single researcher. Although the authors consulted regularly during the analytic process, having multiple people interact with the data and iteratively coding it together could have yielded different insights or interpretations.

Conclusion

Our study demonstrates the promise of aligning contemporary efforts on “successful aging” at the societal level with a burgeoning literature on AFC initiatives. Although scholars have theorized ways in which improving the age-friendliness of communities can promote “successful aging” and related benefits at the individual level (e.g., Hong et al., 2023; Scharlach, 2017), our study is the first to our knowledge to comprehensively connect these discourses in terms of promoting “successful aging” at the societal level. Continuing to advance program theory for AFC initiatives, especially as systems-change work, can bolster future research and praxis to better achieve the promise of “successful aging” for society as a whole.

Funding

This study was supported by The Henry and Marilyn Taub Foundation.

Conflict of Interest

None.

Data Availability

Data from this study are not available to other researchers in accordance with the study’s human subjects protocol, as approved by the Rutgers University Institutional Review Board. This study was not preregistered.

Acknowledgments

We thank the participants for their generosity in sharing with us their reflections on their practice. We also acknowledge and extend thanks to the Connecticut Age Well Collaborative, which hosted a webinar in October of 2023 that reminded us of the “Water of Systems Change” framework and its potential for advancing thought leadership on age-friendly communities.

References