Extended Abstract
1. Objectives
At the moment, more than half of the world’s population lives in cities, and their number is steadily increasing [1, 2]. Urban population growth is more pronounced in developing countries, and it is expected that three-fifths of the world’s population will live in these cities by 2030 [3]. Based on the latest census results in Iran (2016), the population of people aged 60 years and over is 9%, i.e. 7 million people. Therefore, the demographic pattern in Iran, like other countries, is changing towards aging [4]. The process of creating an elderly-friendly environment is a key challenge for policymakers at the international level [3].
The World Health Organization in 2007 launched the project of determining age-friendly cities based on a checklist. This checklist was reviewed in 2012 and then in 2013 and was summed up to 21 indicators. The main goal of the age-friendly cities was to facilitate the active aging process [5]. The purpose of this study was to compare the attitudes of the elderly and managers toward the status of indicators of the age-friendly cities. 
2. Methods and Materials
In this descriptive-analytic study, the researchers compared the views of 379 elderly, who were selected via random sampling, and 57 managers, who were selected via sampling method. The research population for managers was obtained from centers related to the elderly people (Municipality; Welfare Organization; Imam Khomeini Relief Committee; Deputy of Medical Sciences; Health Centers; Physical Education; Islamic Republic of Iran Broadcasting Corporation; Department of Islamic Culture and Guidance; Co-operative Organization, Labor and Social Welfare; Department of Housing and Urban Development; Road Administration; The Department of Justice; and the City Council). Research population for the elderly was all the elderly in Sari City. Inclusion criteria for the elderly were age of 60 years and above and the ability to answer questions. Exclusion criterion for both the managers and the elderly was the lack of cooperation. Family Physician Database was used to access data regarding the elderly. After providing their name and address, 24 physicians were selected randomly from the three regions of the city using a random number table, and the elderly they support were interviewed. Permission was obtained from the Ethics Committee of Mazandaran University of Medical Sciences (IR.Mazums.REC.95-2310).
Data collection method included demographic characteristics and Checklist of the World Health Organization (WHO) (2013) including 21 indicators [6], along with the 5-point Likert scale (Very good, good, bad, very bad, and I do not know). After obtaining permission from the World Health Organization, the translation and retranslation process was carried out by two fluent English and Persian speakers outside the research team and was confirmed by content validity method [7]. Simplicity and difficulty of the questionnaire were evaluated and verified by 6 elderly persons with different levels of literacy (illiterate, elementary, and secondary levels). Reliability of the questionnaire was determined by Cronbach’s alpha of 0.76. Using descriptive statistics (mean, standard deviation, percentage of frequency) and inferential statistics (gamma test) and SPSS software version 21, data were analyzed.
3. Results
Among the 57 managers surveyed, 22.8% (13 persons) were women, and 77.2% (44 people) were male. Among the 379 elderly persons surveyed, 64.9% (246) were female, and 35.1% (133 people) were male. The average age of managers was 39.78±5.37 years (age range: 30 to 51 years, median was 40 years, and with a 95% confidence interval of 38.36 to 41/21). The mean age of the elderly was 68.31±8.25 years (age range: 60 to 89 years, median of 65 years, and with a 95% confidence interval of 67.47 to 69.14).
Among the 379 elderly, 29.3% (111 people) were illiterate, 38.5% (146 people) had under the diploma education level, 18.5% (70 people) had diploma, and 13.7% (52 people) had a degree above the diploma. In terms of income status, 57.5% of the elderly (218 people) had income less than expenses, 38.3% (145 people) had income equal with their expenses, and 4.2% (16 people) had income level more than expenses. In terms of living companions, the majority of the elderly (50.1%, 190 people) lived with their spouse, 19.8% (75 people) lived with spouse and child, 17.4% (66 people) lived with children, and 12.7% (48 people) lived alone. In terms of performance status, 88.4% (335 people) were independent, and 11.6% (44 people) were dependent. Findings revealed that there is a significant difference between the viewpoints of the elderly and the managers in 13 indicators out of 21 indicators.
A significant portion of the elderly believed that there is no place to get information in order to eliminate health concerns and the service needs of the elderly and assessed the following as bad to very bad: Policies to build new housing according to the needs of the elderly, accessibility status for people with motorized problems to private parking lots, access of people with various disabilities to city buses, the status of receiving guidance on how to spend leisure time and recreational programs, the status of giving information about employment status and voluntary activities, and the status of Internet access at home. However, the percentage of managers who had such a view was significantly lower. The number of elderly people who were not dissatisfied with access to computers and the internet in public places and considered the health insurance bad was significantly more than managers. Percentage of the elderly who believed that the state budget of a city that is dedicated to health is very good was significantly less than the managers. Number of managers who believed that older people feel alienated due to age discrimination was significantly more than elderly. Elderly are significantly more likely to participate in social activities and considered physical activity more than managers.
4. Conclusion
Succeeding in achieving the Elderly-Friendly environments needs partnership of policy makers, managers of institutions and agencies responsible for aging affairs, gerontologist and elderly associations. There is a place to get information to eliminate health concerns and the needs of the elderly; policy making to build new housings according to the needs of the elderly; providing the opportunity for participation in formal education programs and voluntary activities; providing the opportunity for participation in cultural, artistic, and sport activities; providing access for people with motorized problems to private parking lots; access of people with various disabilities to city buses; the availability of computers and the Internet in public places, providing guidance for how to spend and use leisure time and recreational programs; improving the health insurance status; improving urban budget condition which is dedicated to health; all are among the things that need to be addressed as priorities in the agendas of the managers.
Ethical Considerations
Compliance with ethical guidelines
This research was approved by Ethics Committee of Mazandaran University of Medical Sciences with the Code of IR.Mazums.REC.95-2310.
Funding
This article is the result of a research project approved by Mazandaran University of Medical Sciences with a code of IR.Mazums.REC.95-2310.
Conflict of interest
The authors declared no conflicts of interest.
Acknowledgements
We thank the deputy of the research and health department of Mazandaran University of Medical Sciences, and dear elders and directors of the institutions who helped us with this research.

1. United Nations Department of Economic and Social Affairs. Population aging 2006. New York: UN DESA; 2007.
2. United Nations Department of Economic and Social Affairs. World economic and social survey 2007: Development in an ageing world. NewYork: UN DESA; 2007.
3. United Nations Population Fund .Urbanization: A majority in cities. New York: UNFPA; 2015.
4. World Health Organization. A billion voices: listening and responding to the health needs of slum dwellers and informal settlers in new urban setting. Geneva: World Health Organization; 2005.
5. United Nations Department of Economic and Social Affairs. World organization prospects: The 2005 revision. New York: UN DESA; 2006.
6. Hu J, Tsai PK, Huang MN, Tsay SF. [Age friendly cities, ideals and practice: The experience of Taichung city (Chinese)]. Hu Li Za Zhi. 2012; 59(6):5-11. [DOI:10.6224/JN.59.6.5]
7. Taheri Tanjani p, Azadbakht, M. [Psychometric Properties of the Persian Version of the Activities of Daily Living Scale and Instrumental Activities of Daily Living Scale in elderly (Persian)]. Journal of Mazandaran University of Medical Sciences. 2016; 25(132):103-12.
8. World Health Organization. Measuring the age friendliness of cities: A guide to using core indicators. Geneva: World Health Organization; 2015. 
9. Plouffe L, Kalache A. Towards global age friendly cities: determining urban features that promote active aging. Journal of Urban Health. 2010; 87(5):733-739. [DOI:10.1007/s11524-010-9466-0]
10. Keller IM, Kalache A. Promoting healthy aging in cities: The healthy cities project in Europe. Journal of Cross-Cultural Gerontology. 1997; 12(4):287–98. [DOI:10.1023/A:1006539003961]
11. World health Organization. Checklist of essential features of age-friendly cities. Geneva: World Health Organization; 2015.
12. WHO Centre for Health Development. 2nd WHO consultation on developing indicators for age-friendly cities. Geneva: World Health Organization; 2013. 
13. World health Organization. Active ageing: A policy framework. Paper presented at: The Second World Assembly on Ageing. 8-12 April 2002; Madrid, Spain.
14. Zarghani SH, Kharazmi OA, Johari L. [Evaluation of the “Age-Friendly” city indicators in Mashhad by focusing on the social-cultural indices (Persian)]. Human Geography Research. 2016; 47(4):673-88. [DOI:10.22059/JHGR.2015.51385]
15. Kharazmi OA, Zarghani SH., Johari L. [Evaluating spatial – physical indictors in Mashhad to become “age-friendly” city (Persian)]. Joghrafia va Amayesh-e Shahri. 2015; 5(15):177-96.
16. Nemati D, Agha Bakhshi H. [Tehran an age friendly city: first steps towards first capital of aging in the world (Persian)]. Social Research. 2013; 6(18):15-44.
17. Foroughmand Arabi H, Karimi Fard L. [Age friendly city design criteria centers of social interaction with the concepts of space and culture approaches to mental health (Persian)]. Urban Management. 2015; 39:7-34.
18. Wikipedia. List of Iranian cities by population [Internet]. [Updated 2018 April 11] [Internet]. Available from: https://en.wikipedia.org/wiki/List_of_Iranian_cities_by_population
19. ISNA. [Population aging is increasing in Mazandaran (Persian)] [Internet]. [Updated 2016 October 1]. Available from: https://www.isna.ir/news
20. Polith D, Beck F. Nursing research: Appraising evidence for nursing practice. Philadelphia: Lippincott; 2012.
21. Neal MB, Dela Torre AK. Carder PC. Age-friendly portland: A university- city- community partnership. Journal of Aging & Social Policy. 2014; 26(1-2):88-101. [DOI:10.1080/08959420.2014.854651]
22. Garon S, Paris M, Beaulieu M, Veil A, Laliberté A. Collaborative partnership in age-friendly cities: Two case studies from Quebec, Canada.Journal of Aging & Social Policy. 2014; 26(1-2):73-87. [DOI:10.1080/08959420.2014.854583]
23. Buffel T, McGarry P, Phillipson C, De Donder L, Dury S, De Witte N, et al. Developing age-friendly cities: Case studies from Brussels and Manchester and implications for policy and practice. ournal of Aging & Social Policy. 2014; 26(1-2):52-72. [DOI:10.1080/08959420.2014.854583]
24. Kendig H, Elias A-M, Matwijiw P, Anstey K. Developing age-friendly cities and communities in Australia.  Journal of Aging and Health. 2014; 26(8):1390-414. [DOI:10.1177/0898264314532687]