Introduction

In its call for action to improve well-being of older persons, The United Nations Decade of Healthy Ageing (2021–2030) positions communities as particularly important. It calls for nations around the world to ensure that communities foster the abilities of older people, by creating age-friendly environments that are good places to “grow, live, work, play and age” (WHO, 2020).

The global interest in age-friendly communities is an indication of the salience of communities as a focal point for ageing. Yet community action to support older people requires community capacity to do so. In the preface to her book on Environments of Ageing, Peace articulates this question for researchers, challenging us to “consider how older people in specific circumstances find their environment enabling or disabling” (Peace, 2022, p.xvi).

Our interest in conducting this study was to advance the global conversation about communities and the well-being of older adults. We focus on rural communities in the global south where the proportion of older persons is higher than in the global north (Amoah & Phillips, 2020) and where communities themselves may be marginalised (de-Lima-Santos & Mesquita, 2021). The purpose of this study was to determine the state of knowledge of the elements of rural communities across CESW Africa and LA that may enable or constrain older adults’ well-being.

Methods

Study Design

Scoping review methodology was chosen as it is an appropriate approach to synthesise research on a broad topic area to articulate the current state of knowledge and address research gaps (Arksey & O'Malley, 2005; Colquhoun et al., 2014; Peterson et al., 2017). For this study, the scoping review was conducted following the PRISMA-Extension Guidelines (Tricco et al., 2018), represented in (Fig. 1).

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PRISMA flow chart

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To enable a comprehensive review of publications from the regions of Latin America and CESW Africa, specific databases were used based on region and language. Searches were completed both in English and in Spanish, the main languages of the regions, using standard and region-specific databases. No language filters were used in the searches, thus allowing for articles in Portuguese, French and Africaans. Eleven databases were searched: 7 in English; 4 in Spanish. Using English search terms, the databases MEDLINE, CINAHL Complete, PsycInfo, SocINDEX with Full Text (via EBSCO), Web of Science Core Collection, Scopus, Social Care Online, Sociological Abstracts, AJOL African Journals Online, and SciELO citation index South Africa were consulted. Using Spanish search terms, the databases SciELO citation index in Spanish, LILACS (Spanish acronym for Latin American and Caribbean Health Science Literature), CLASE (Spanish acronym for Latin American Citation in Social Sciences and Humanities), and DialNetPlus were consulted. A detailed description of the search methodology is available at Curreri et al. (2022).

Region-specific databases offer access to local journals and studies that may not be accessible through standard, English language database searches. The distinct search and extraction methods across the databases require more ground work in organising and consolidating results, but result in a more comprehensive and exhaustive review. A multi-national multi-lingual team of researchers from the two regions allowed for the multiple language search and inclusion of results in the main languages of the regions: English, Spanish, Portuguese, French and Afrikaans. No articles in French or in Africaans met the screening criteria.

Inclusion and Exclusion Criteria

Inclusion criteria included peer-reviewed sources published between 2010 and 2021; in English, Spanish, Portuguese, French or Afrikaans; from a Latin American or CESW African country. The key search terms were determined in English and Spanish maintaining culture-specific terms for the main concepts. The population of interest was rural and/or remote communities. Following initial searches, two sub-concepts: community characteristics and older adults were added to reduce the large quantity of irrelevant results. The context of interest was the countries of Latin America (20), and CESW Africa (48). Papers were excluded if they did not meet these criteria or if the full text was irretrievable.

Search Terms

Key words were determined in English then translated into Spanish. For both sets of terms, consultations with team members whose native language was English or Spanish confirmed appropriateness of local syntax, terminology and relevance. Blocks of key terms were created for population, concept, and context, and were used in different combinations to ensure exhaustive searches. Where a database limited the number of search terms, search trials were performed to capture the most relevant results.

Data Extraction

After removing any duplicates and adding key articles, 1,341 records were identified. These were first screened by title by two independent reviewers, one for English and one for Spanish records. A third reviewer screened the titles in Portuguese, French and Afrikaans, and served as second reviewer for English and Spanish titles. Any discrepancies were discussed and resolved. This phase excluded 696 records in English and 309 in Spanish, Portuguese, French, Afrikaans. Abstract screening was performed in the same manner, yielding a total of 79 records for the full text screening. Full text screening excluded 39 articles based on the inclusion criteria, resulting in 40 articles identified for inclusion in the qualitative synthesis. No articles in French or Africaans were part of the final set of articles.

Full text review was also completed by two researchers, one extracting data from the English language results, the other from the Spanish and Portuguese language results. To ascertain reliability, data were extracted by both researchers from a small random sample (n = 4) of Spanish and Portuguese articles also available in English, and a small random sample of articles retrieved from the English search (n = 8). Where there was disagreement, reviewers discussed their decisions and were able to reach consensus regarding inclusion.

Extracted data were inserted into an excel spreadsheet, then reassessed and regrouped through an interactive process into more specific codes in preparation for thematic analysis (Braun & Clarke 2012). This process led to ten codes on community elements influencing older adults’ well-being. These were re-examined and reorganised by the researchers into three main themes with subthemes (Table 1). Table 2 provides country, study design, and relevant theme(s) for each paper.

Table 1 Thematic coding legend
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Table 2 Thematic coding
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Results

Sixty-three percent of the studies included in this review (n = 25) represent Latin America and 45% (n = 18) represent CESW Africa. Eight CESW African countries are represented, and eight Latin American: Ghana, Nigeria, Senegal, South Africa, Tanzania, Uganda, Zambia, Zimbabwe; and Argentina, Brazil, Chile, Colombia, Cuba, Ecuador, Guatemala, Mexico. The majority of the studies are qualitative, presenting the views of the residents of the communities, older adults, family caregivers, health and care workers/providers, traditional healers, volunteers, and community members. In response to global policy about communities, the insider perspective lends a critical realistic lens (Scott, 2007).

Results indicate three main elements of communities that are important in supporting the well-being of older adults. They are: local environments, community relationships, and cultural identity.

Evidence from the review shows that with a few, localised exceptions, rural communities across CESW Africa and Latin America are not adequately resourced to maintain these three elements.

Theme 1 Local Environments

Eighty-three percent of the studies (n = 33) present data on the relevance of local environments to the well-being of older residents (see Table 1). Featured in these studies are natural and built environments that influence access to services and livelihoods. Salient features of local environments are: lack of local infrastructure; community ability to support local industries; and community capacity to prevent land degradation and ensure water security.

Infrastructure

Twenty-six studies address challenges arising from lack of community infrastructure and health services and difficulty accessing these services at a distance.

There is little evidence of the presence of infrastructure to enable older residents to go outside of their communities. Studies in Ecuador, Brazil and Tanzania report that leaving or entering their communities is difficult because of terrain that is high altitude, or roads are impassable during the rainy season (Borghi et al., 2013; Porter et al., 2013; Waters & Gallegos, 2014). Transportation infrastructure in both regions is commonly described as precarious. Researchers in Chile, Ecuador and Tanzania describe roads that are poor quality and unpaved (Gallardo-Peralta et al., 2016; Porter et al., 2013; Waters & Gallegos, 2014). Even within local communities, limited public lighting at night restricts movement (Gallardo-Peralta et al., 2016; Rodriguez et al., 2016).

The majority of studies address healthcare in rural communities. There were no studies on services such as food, clothing or banking. One study provided data on housing in Tanzania with the oldest heads of households to be more likely to have earth floors and wattle and daub constructions (Mshamu et al., 2020). However, research on health clinics illustrates widespread issues of access. Clinics are rarely located within rural communities and distance to clinics is a barrier in both regions. At best, health clinics are in the next village (Ibanez-Gonzalez & Tollman, 2015), though for many they are several hours walking distance away (Borghi et al., 2013; Chang et al., 2019; Chimberengwe & Naido, 2019; Ibanez-Gonzalez & Tollman, 2015; Olusanya et al., 2016; Omotayo & Aremu, 2020; Parmar et al., 2014; Pelcastre-Villafuerte et al., 2017, 2020; Porter et al., 2013; Waters & Gallegos, 2014). Unaffordable transportation costs prevent older people from reaching care facilities (Pelcastre-Villafuerte et al., 2020; Waters & Gallegos, 2014). Affordable public transportation is virtually absent. Only one study described local transportation, a bus service in a Brazilian community that transported older people to and from the local health unit and around the village (Rissardo & Carreira, 2014).

Overall, shorter distances between an older adult’s home and a healthcare facility are associated with higher likelihood of seeking care (Olusanya et al., 2016). However, even when available, the quality of care is reduced due to small physical structures, high turnover of staff, limited hours and waiting times, and confusion caused by the variety in types of care (Borghi et al., 2013; Chary et al., 2012; Pelcastre-Villafuerte et al., 2020; Rissardo & Carreira, 2014; Waters & Gallegos, 2014).

Local Industry

Thirteen studies address the importance of local environments in providing livelihoods for older adults who in turn are able to contribute to local economies through industries such as agriculture, tourism, and artisanry.

In both Latin America and CESW Africa, the main current or former employment of the vast majority of older adults is in agriculture (Waters & Gallegos, 2014; Vázquez Palacios, 2013; Pelcastre-Villafuerte et al., 2020; Mshamu et al., 2020). Older adults who are small farmers have limited trading possibilities as they rarely produce a surplus beyond their own consumption (Porter et al., 2013). Policies favouring commercialised crops compound older adults´ struggle (Omotayo & Aremu, 2020). The growing presence of industrialized agriculture and intensified production of crops such as sugarcane, exclude older adults from employment since the work is so physically challenging (Vázquez Palacios, 2013).

Against this backdrop of changes in livelihoods is research on how natural resources can provide a basis for community enterprises that support older people through eco and agro-rural tourism. Traditional foods, medicines, and natural beauty provide a source of community income and opportunity to spread traditional knowledge and customs. Research in Ecuador shows that waterfalls and streams that attract tourists are well maintained by communities that support this asset (Trujillo et al., 2018). In Mexico, produce from local orchards is sold at fairs and markets that attract tourists; as do the mountains, caves and rivers, and baths and massages combined with traditional medicines (Galán Cuevas et al., 2019). In Colombia plants from areas settled by indigenous people are used for artisanry and sales to tourists (Garavito et al., 2021). Skills in creating products from local bamboo are passed on through the generations by the older adults, maintaining traditional crafts in communities, providing family income (Camarillo et al., 2020; Borghi et al., 2013; De La O-Romero et al., 2016) and allowing people living with disabilities to remain active participants (Camarillo et al., 2020).

Land and Water Maintenance

Eleven studies highlight the maintenance of local land and water sources to be essential for the livelihoods of older persons.

For older adults, the land is the most valuable means of production (Vázquez Palacios, 2013). It is home to a diversity of fauna and flora that sustain the local industries, provide medicinal remedies, and are used in traditional foods (Galán Cuevas et al., 2019; Vázquez Palacios, 2013). Indigenous plants aid in alleviating food and nutrition security in Mexico and South Africa (De La O-Romero et al., 2016, Omotayo & Aremu, 2020; Pelcastre-Villafuerte et al., 2020). However, the intensification of industrial agriculture, brewery and lumber industries, and mills, has resulted in lower crop productivity, a decrease of forest coverage, and the disappearance of some species of fauna (Barrasa García, 2012). Widespread clearing of vegetation and contamination of the water in the areas where fish reproduce such as mangroves, lead to the reduction in the variety and quantity of fish (Vázquez-Palacious, 2019).

Water security is an issue in both Latin America and CESW Africa. Residents in the Fakcha Llakta community in Ecuador indicate major concerns about water contamination and scarcity (Trujillo et al., 2018). In South Africa, water infrastructure is threatened by inadequate maintenance, vandalized infrastructure and ownership not entirely under community control (Hove et al., 2019). Communities in Tanzania and South Africa are challenged to provide access to clean water because of unregulated community wells and public taps and contaminated rivers and lakes (Hove et al., 2019; Mshamu et al., 2020); while in Nigeria, costs to dig wells to provide safe water are prohibitive (Nwankwoala, 2011). Few families have piped water available in their homes, and it is common for water to be between 10 to 30 min walking distance away (Porter et al., 2013). Water is also necessary for agriculture as are irrigation systems that minimze waste (Setshego et al., 2020). Barriers to community-based water management programs in South Africa include limited capacity in administration and financial management (Hove et al., 2019).

Theme 2 Community Relationships

Sixty-five percent (n = 26) of studies represent formal and informal connections that comprise the social fabric of a community (see Table 1). Formal partnerships and strategies operate as agreements between a community and external organisations and/or regional/national multisector agencies, to provide programs or services. Within communities, groups such as clubs and seniors´ associations can foster a sense of belonging and trust, protect older adults´ rights, and support community change and development.

Formal Partnerships, Strategies, & Programs

Partnerships, collective strategies, and programs are highlighted in 18 studies. Agreements between community agencies and regional or national agencies, or external service providers are intended to secure the delivery of coordinated efforts of service and infrastructure that can be supportive to older adults.

Researchers in Argentina (Rebollo & Paz, 2019) and Cuba (Rodriguez et al., 2016) argue that community development can be enhanced through shared social policies across sectors. Evidence comes from Mexico, where community and external groups collaborate on agricultural production (Vázquez Palacios, 2013). In the Inca culture, the internal management of the community by the community is a traditional practice; the Quechua word minga denotes a community strategy of rotation of duties shared amongst community residents (Trujillo et al., 2018).

Examples of efforts to create partnerships to benefit older adults are found in nearly every country included in this review (Borghi et al., 2013; Chimberengwe & Naido, 2019; De La O-Romero et al., 2016; Parmar et al., 2014; Pelcastre-Villafuerte et al., 2020; Pereira & Santos, 2018; Reyes-Rincón & Campos-Uscanga, 2020; Tungu et al., 2020; Wiru et al., 2017). From pension and health insurance plans to training and management programs of village health workers and multidisciplinary indigenous health teams, strategies directed at rural older adults are agreed upon with communities. Yet communities appear to have little power or capacity to administer or deliver such benefits (Rissardo & Carreira, 2014). The lack of funding and other resources halt community-based possibilities like educational programs in Uganda (Chang et al., 2019).

Community Groups

Eleven studies provide evidence of community groups linking older adults to each other and to the greater community. Examples are: senior clubs, faith-based groups, indigenous groups and neighbourhood collectives, that promote active community participation in South Africa, Chile, Mexico, Colombia, and Tanzania (Ibanez-Gonzalez & Tollman, 2015; Gallardo-Peralta et al., 2015; De La O-Romero et al., 2016; Gallardo-Peralta, 2013; Porter et al., 2013). Social participation of older adults also occurs through public positions and roles in councils and rituals (Gallardo-Peralta, 2013; García-Acosta et al., 2016). Community hypertension clubs in Zimbabwe deliver education on self-care and training on medicines (Chimberengwe & Naido, 2019). Nigerian community members participate in the maintenance and operation of water projects for example through creating accountability with community committees (Nwankwoala, 2011).

Challenges in developing and maintaining community connections are apparent in lack of privacy in small villages with dense social ties that increase negative gossip and socio-economic divides in Argentina (Rebollo & Paz, 2019). Studies have shown sporadic and limited community connections and support in Cuba (Rodriguez et al., 2016) and Ecuador (Waters & Gallegos, 2014).

Theme 3 Cultural Identity

Sixty-three percent of the studies (n = 25) addressed the relevance of cultural elements of communities to the well-being of older adults (Table 1). Community cultural identity incorporates languages, values, traditions, and practices that can foster inclusion of older adults, though ethnic minorities risk marginalisation. Three main categories of community cultural identity emerged: values and traditions, cultural practices, and language.

Values & Traditions

Fourteen studies address the importance of recognition and respect of diverse values and traditions by community and external members. There is evidence of a socio-cultural divide between external service providers and indigenous older adults (Waters & Gallegos, 2014). Indigenous older persons in Chile manifest physical symptoms and higher rates of depression (Gallardo-Peralta et al., 2015, 2016). Belonging to specific ethnicities or religions is associated with lower rates of having health insurance in Senegal and Ghana (Parmar et al., 2014), and food insecurity in South Africa (Omotayo & Aremu, 2020). Older adults fear losing their native legends, customs, and traditions (Hove et al., 2019; Rodriguez et al., 2016) to which they are deeply attached, and that guide their spiritual and medical decisions (Pelcastre-Villafuerte et al., 2020).

Practices

Community cultural practices (14 studies) foster inclusion of older adults in community participation. Traditional knowledge is commonly transmitted orally by the older adults (Garavito et al., 2021), spanning local craftsmanship (Camarillo et al., 2020), native plants (Garavito et al., 2021), and ethnic specific beliefs like the Kaingang indigenous cosmology, in Brazil (Borghi et al., 2013). Cooking and cosmetics using local indigenous plants alleviate some older adults´ food insecurity while maintaining traditional recipes and folk practices in Mexico and South Africa (Barrasa García, 2012; Omotayo & Aremu, 2020; Setshego et al., 2020). Using traditional dramas and songs to transmit health education in Zimbabwe (Chimberengwe & Naido, 2019) and health promotion actions in Brazil (Pereira & Santos, 2018) enhances older adults´ inclusion. Water awareness practices, transmitted by elders in rural Ecuador, are helpful in gathering community commitment to sustaining water through intergenerational education and training (Trujillo et al., 2018).

There is evidence of inequality in health care practices where older adults are treated poorly and made to wait for medical attention even if arriving first in healthcare centres (Pereira & Santos, 2018; Tateyama et al., 2019). Traditional remedies are favoured by many older people who perceive traditional remedies and healing practices as more reliable, more trusted, and more easily accessible than external healthcare (Chimberengwe & Naido, 2019; Waters & Gallegos, 2014; Ibanez-Gonzalez & Tollman, 2015; Barrasa García, 2012; Pelcastre-Villafuerte et al., 2020; García-Acosta et al., 2016).

Language

In eight studies, language emerges as an important element of community cultural identity. Most examples of exclusion based on language come from difficulties with access to health services. Older adults often speak native indigenous languages (Galán Cuevas et al., 2019). Their language preferences and abilities are barriers to receipt of services (Borghi et al., 2013; Chary et al., 2012; Pelcastre-Villafuerte et al., 2020; Waters & Gallegos, 2014).

Health services providers are often external to a community and do not share culture or language with older users, impeding communication and producing fear in the elders (Borghi et al., 2013; Pelcastre-Villafuerte et al., 2017; Waters & Gallegos, 2014). In both Mexico and Brazil, language is a barrier to diagnosis and treatment (Pelcastre-Villafuerte et al., 2020; Rissardo & Carreira, 2014).

Discussion

The results of this review provide evidence of elements of rural communities that are important in fostering well-being of older adults, but that also may lead to well-being failures. Together they provide a basis for understanding areas of emphasis for building community capacity, addressing knowledge gaps and moving toward a “good fit” between community environments and older persons.

Themes of local environments, community relationships and cultural identity reflect previous research and theorising in environmental gerontology and rural ageing about the importance of community physical environments, social connections, and inclusion (Bhuyan & Yuen, 2021; Bigonnesse & Chaudhury, 2020; Mahmood & Keating, 2012; Winterton et al., 2020). They also add to our understanding of the specific circumstances of these communities that are foreshadowed by Peace (2022) who reminds us that places are constructed within broader political, social and regional influences and settings.

The theme of local environments illustrates the centrality of natural settings of land, water and topography in supporting livelihoods in agriculture and tourism, and as a source of food and traditional medicines. Yet the natural environment is also a barrier. Destruction of habitat and contamination of water sources threaten economic well-being. Communities lack health care clinics but are unable to provide transport to more distant services because of difficult terrain. These findings in part reflect those of Winterton et al. (2016) who identify the “resource environment” of natural, built, and service contexts of rural communities as central to the well-being of older persons. Yet our findings are almost exclusively about the importance of natural environments. It may be that essential elements of the built environment such as housing are not seen as a community resource but as an individual responsibility. Lack of research on community services except for health care seems to be a large data gap given the importance of a variety of services such as internet connections and banking (UNDESA, 2021).

The second theme of community relationships includes formal relationships between communities and outside groups and organisations within communities. Partnerships with external organisations are not usually a central element in research on community connections that support older persons. Their presence suggests that communities may use such strategies to augment their ability to ensure that older adults receive the services they need (Rissardo & Carreira, 2014). Yet communities in these regions often have limited economic capacity (Amoah & Phillips, 2020), political influence or administrative autonomy (Kröger, 2022). We do not know the extent to which such limitations hamper communities’ ability to broker services; or similarly to influence reductions in land degradation, support local producers and ensure food and water security that are challenges evident in the theme of local environments.

Community-based organisations often are seen as the heart of social connections, especially in rural communities (Gallardo-Peralta et al., 2016). Our review illustrates findings that support their importance, but also some evidence that very dense social ties can reduce privacy. A data gap is the extent to which communities have the resources to organise and support such activities.

The third theme, community cultural identity, highlights how community values and behaviours can include some older adults while excluding others. Recognition and support of indigenous languages and cultural practices are viewed as important across countries. However, communities’ ability to influence such things as ethnically sensitive service provision external to the community may be limited. Prior research illustrates how experiences of ethnic discrimination contribute to inequalities in wellbeing (Nazroo & Williams, 2006). They illustrate how even long-standing residents of a community can be excluded (Walsh et al., 2020).

Conclusion

Evidence from this review leads us to three main conclusions. The first is that calls for action to communities to support older persons must be addressed within constraints of their control over such actions. Constraints may come from policy responsibility at state or regional levels for services such as primary health care or from limited resources within communities to provide basic amenities such as potable water. They also may arise from the designation of rural communities themselves as “remote” or “bypassed” in ways that may underscore their exclusion (Keating et al., 2013). Wang (2022) cautions against taking rural at face value, instead engaging with the language politics of rural research.

The second is that widespread exclusion of older persons because of language and cultural traditions warrants attention to address the imperative in recent UN declarations to leave no one behind. We believe that our framing of the research across two large regions of the global south and collaborative authorship on this paper, has gone some way toward being more inclusive of knowledge created in different regions and by researchers who publish in different languages. There is more to be done in representing communities with indigenous languages and people whose voices are not heard directly in these research settings.

Finally, findings do not allow us to make comparisons across regions or to determine country-specific particularities in community opportunities or challenges to improving well-being of older persons. Knowing how specific rural places are actually working is the first step to planning for better places (Gkartzios et al., 2020, 2022) and ultimately improving the well-being of older persons who live there.