Assessing Older Adults’ Walkability in the Surroundings of Primary Care Centers: A Three-Case Study from Barcelona

Abstract

This study aims to explore the walkability of three small areas (basic healthcare areas) of Barcelona city (Catalonia, Spain) for frail older adults. A mixed methods study design was conducted with 132 frail older adults in three primary care centers of Barcelona: Larrard, Barceloneta, and Vila Olímpica. A literature review was conducted to identify urban design indicators related to walkability and the aging population. These were then reflected in the surveys administered to the program participants, capturing information on their preferred routes, usual destinations, and walkability perceptions. Findings reveal significant mobility challenges for older adults, particularly the ones related to safety issues, the adequacy of sidewalk widths, greenery and urban furniture maintenance, and the presence/absence of commercial activities. This research underscores the importance of age-sensitive urban design in healthcare environments and provides a framework for enhancing walkability and accessibility for populations at greater risk of mobility-related health problems, such as frail older adults.

1. Introduction

1.1. Frail Older Adults and Walkable Urban Environments

As populations age globally, cities face the pressing challenge of designing urban environments that support older adults’ physical, mental, and social well-being. Walkable urban spaces—those that allow safe, convenient, and pleasant pedestrian access—play a crucial role in enabling older adults to maintain their independence, health, and quality of life [1]. This is particularly relevant for frail older adults who have a higher risk of falls and worse prognosis. Studies indicate that an accessible and inclusive urban design benefits older adults by encouraging physical activity, reducing isolation, and increasing community engagement [2,3].

The benefits of walkable environments for older adults extend beyond physical health. Social participation and mental well-being are also strongly influenced by an individual’s ability to engage with their surroundings, something urban environments can support by offering accessible sidewalks, adequate lighting, and benches along common walking routes. Recent studies emphasize that walkability in older populations goes hand in hand with reducing the risks associated with isolation and dependency, thus creating resilient, age-friendly communities [4]. Despite these benefits, urban areas often lack infrastructure designed to meet older adults’ specific needs, contributing to the risk of injuries, limited access to public amenities, and lower quality of life [5]. However, walkability requirements are often overlooked in urban planning, resulting in environments that limit older populations’ mobility and access to essential services, including healthcare services [6].

The barriers to creating walkable urban spaces for older adults are manifold and multifaceted, ranging from physical to socioeconomic factors. Key physical barriers include limited accessibility features like ramps and handrails, uneven pavements, inadequate lighting, and a lack of safe pedestrian crossings. Additionally, many urban planning efforts often overlook the physical limitations of older adults, such as reduced mobility, visual impairment, and a lower tolerance for distances. These obstacles restrict mobility and contribute to feelings of insecurity and vulnerability, deterring older adults from engaging in regular walking activities and limiting their access to social and healthcare services [7]. For these reasons, this study focuses on urban design aspects and variables, since they are considered important causes of physical, mental, and social fragilities in older people.

Creating universally walkable environments is particularly challenging because urban conditions vary widely across cities and regions. What may constitute a safe and walkable environment in one city may be impractical or unsafe in another due to differences in the urban density, cultural norms, or public transportation infrastructure.

In Europe, the development of age-friendly cities has been prioritized through various policies and programs, such as the European Innovation Partnership on Active and Healthy Ageing and the Age-Friendly Cities program initiated by the World Health Organization (WHO). These programs encourage cities to adopt designs that enhance accessibility and safety, including pedestrian-friendly streets, integrated public transportation, and senior-specific amenities such as benches and covered resting areas [1,8]. European cities, particularly in Scandinavia and the Mediterranean area, have made substantial progress in age-friendly urban planning. Still, they continue to face obstacles such as high-density traffic and a growing number of non-traditional mobility devices, including bicycles and scooters, that compete for pedestrian space [9].

Despite the progress in policy, research suggests that older adults in European cities often face unique challenges when accessing healthcare and other essential services, underscoring the need for adaptable design standards that cater to seniors’ specific mobility needs. This reality is especially pertinent in high-density areas where pedestrian and wheeled mobility interactions are frequent and occasionally hazardous for older individuals.

1.2. Study Background: The +AGIL Project

In 2016, the team of Primary and Geriatric Care providers led by Parc Sanitari Pere Virgili (Barcelona, Spain) launched the +AGIL research and implementation program, based on an integrated and multidisciplinary approach between primary care professionals (family physicians, physiotherapists, dietitians, nurses, pharmacists, psychologists, and other primary care professionals) and community agents. Through a multicomponent intervention firmly focused on tailored physical exercise and the promotion of healthy habits for frail older adults in the community, +AGIL has demonstrated a positive impact on frailty at 3 and 6 months, even in individuals with cognitive impairment [10,11,12,13].

Between September 2023 and July 2024, the program was escalated in three Primary Healthcare Centers (CAP—Catalan acronym for Centre d’Atenció Primaria)—Larrard, Barceloneta, and Vila Olímpica (Figure 1). The present study was conducted together with a sub-sample of participants from the primary study +AGIL and was also led by a multidisciplinary research team of health professionals, architects, and urban planning experts.

The aim of this study—named from now on “Urban +AGIL”—is to assess the walkability level of three small areas of Barcelona city (Catalonia, Spain), focusing on the older adults’ population and the urban healthcare environments. Therefore, the first objective is to define the indicators related to the urban space (and its quality) and then to understand how these factors influence the individual choices of frail older adults when deciding on the route to take from home to the healthcare center.

Barcelona represents a unique case within European urban design as it has implemented progressive mobility policies that emphasize pedestrianization, cycling lanes, and extensive public transit access. The recently published Urban Mobility Plan 2024 is the latest governance tool that establishes the new objectives until 2030. Among these goals, the actions forecasted in the plan aim at increasing pedestrian journeys, the use of public transportation, and, especially, the bicycle implementation [14]. In addition, the plan wants to reduce the use of private vehicles by 25%, reducing it as the last means of transportation. This policy is supported by numerous urban design interventions, such as the Superblock and the Green Axes project, which have been implemented in the Catalan capital over recent years [15,16]. Although these initiatives have positioned Barcelona as a model for sustainable mobility, the needs of frail older pedestrians have not always been prioritized. Indeed, according to this project’s literature review, no previous study has analyzed the walkability of Barcelona in relation to frail older adults, specifically in regard to access to urban healthcare environments. However, some studies concerning the walkability of frail older adults have been identified as pioneers, for their methodology and target, although they miss the healthcare environment’s focus. For example, in their two studies, Alves et al. developed and applied the Walkability Index for Elderly Health (WIEH), a tool designed to assess and improve walkability for older people in urban environments [17]. This first study introduced the conceptual framework of the index, linking walkability factors—such as the public space quality, pedestrian infrastructure, and urban safety—to older adults’ health benefits. The second one validated the index by applying it to Porto’s historic center, classifying pedestrian paths based on their suitability for older adults and highlighting challenges posed by steep slopes, poor infrastructure, and inadequate public amenities [18]. These studies serve as key references for our research because they provide a comprehensive methodological approach to measuring walkability, offer GIS-based analytical tools, and demonstrate practical applications that can inform urban planning and policy-making aimed at promoting age-friendly cities. Indeed, the added value of these studies lies in their ability to bridge theory and practice by applying their index to a real-world context—specifically, the historic center of Porto. While many of the studies referenced in the theoretical framework (and discussed in detail in the following section) remain either purely theoretical or encounter challenges in practical implementation, these works demonstrate a concrete and context-sensitive neighborhood-scale analysis that bridges urban planning principles with real-life spacial configurations.

1.3. Theoretical Framework: Previous Walkability Studies on Frail Older Adults

Walkability is a critical factor in the health and well-being of older adults, and extensive research has documented its role in promoting active aging [19,20]. Urban environments that support walkable access to essential services, green spaces, and opportunities for social interaction are key to fostering autonomy and active lifestyles among older adults, particularly those facing reduced mobility, cognitive decline, or social isolation [21,22,23].

The recent literature has introduced increasingly sophisticated frameworks for evaluating walkability in aging populations, comparing multiple walkability indices, and highlighted the challenges of adapting them to diverse urban morphologies [23] and conducting a systematic review that contrasted general population metrics with those specific to older adults. This study reveals that age-sensitive assessments must prioritize reduced mobility, proximity to healthcare services, and safe, navigable pedestrian environments [24]. These findings underscore the need for nuanced frameworks that go beyond physical urban forms to incorporate the social and functional challenges older adults encounter in everyday mobility.

The World Health Organization’s Age-Friendly Cities initiative provides a foundational framework for embedding universal accessibility into urban development strategies [25]. This approach is also reflected in the previously mentioned works [17,18] that advocate for integrating a fine-grained pedestrian network analysis and age-specific walkability indicators into municipal planning. Nonetheless, a critical complexity remains: understanding how older adults, as the central users of these systems, navigate the urban landscape while coping with heterogeneous physical capacities, cognitive demands, and emotional or social vulnerabilities.

Indeed, while many studies assess walkability through city-scale metrics like the Walk Score [26], few systematically examine its multiscalar dimensions—particularly at the neighborhood level—or integrate both quantitative (e.g., sidewalk width, gradient) and perceptual variables (e.g., safety, comfort) to mitigate scalar bias and consider the specific needs and experiences of older adults. This gap is critical: while city-scale walkability metrics (e.g., park proximity) influence general patterns of mobility, older adults’ walking behavior is predominantly determined by micro-scale features (e.g., pavement texture, bench spacing, curb cuts), which are rarely systematically assessed [4,27].

The Urban +AGIL project aims to address this disjunction by integrating these two dimensions: the scalar approach to urban walkability and the complexities of the “user”—older adults—who navigates these urban spaces. This gap is addressed by combining a neighborhood-scale walkability framework [28] with older adults’ lived experiences. The theoretical framework in this phase draws from studies demonstrating how street connectivity and micro-mobility infrastructure interact with city-wide systems by integrating objective measures (e.g., GIS-based streetscape audits) with perceptual data (e.g., perceived accessibility surveys) [29]. This approach captures the interplay between urban scales and user diversity, moving beyond aggregate-level biases.

2. Materials and Methods

A mixed methods study design was used with qualitative and quantitative techniques for data collection and analyses. This study was divided into five phases, which are briefly summarized in Figure 2.

First, a literature review on the older adult population’s walkability and assessment technique studies was carried out to identify the design variables of urban spaces (and their quality). This led to the identification of 12 unique and measurable urban indicators, as explained in the literature review below. Then, between February and March 2023, two focus groups with healthcare professionals, patients, and experts were conducted (Figure 3). They served to contextualize the team members and acquaint them with participant recruitment protocols for the study. This allowed for the definition of guidelines for the surveys conducted in the third phase of the study.

Between September 2023 and July 2024, a total of 132 surveys were conducted, selecting the participants on a voluntary basis among the ones included in the +AGIL program. People meeting inclusion criteria for the +AGIL program were recruited during their visit with their primary care team. Inclusion criteria were being 65 years old or older and presenting suggestive signs of frailty according to the Geróntopole Frailty Screening Test [30]. One of the researchers and article’s author (BP) contacted the +AGIL Program participants and asked them to participate in the Urban +AGIL on a voluntary basis until we reached a sample of 30–50 participants in each primary care center. The recruitment strategy aimed to ensure a representative sample across the three CAPs, with variation in age, gender, lifestyle, and type of frailty.

The survey’s design aimed to ensure that responses would yield quantifiable insights into the urban elements that either facilitate or hinder walkability for older adults with varying degrees of physical, cognitive, or social frailty. By gathering this data, this study aimed to assess the specific urban indicators that were perceived as either supportive or challenging for older adults in their daily routines in their healthcare reference area. This approach allowed for a comparative analysis of user-reported experiences across different neighborhoods and CAP surroundings. The survey consisted of three parts: First, we collected socio-demographic data (gender, age, marital status), lifestyle (active or sedentary), and type of frailty (physical, cognitive, social). Second, participants were asked to mark on the map the usual routes they used to go from home to their CAP, as well as other frequent routes (e.g., to the market, bank). Third, participants were asked to rate on a scale from 1 to 10 the importance of 12 urban indicators related to street characteristics and components, in the selection of their routes.

Later, the information collected was validated through field visits in the study areas and a group session using the World Café method. All indicators’ weights, survey responses, and route outlines were transferred to urban cartographies, available in an open access viewer [31].

During the World Café—a participatory event held on 21 June 2024, at the Parc Sanitari Pere Virgili in Barcelona—the authors validate the findings from prior data collection phases conducted across three health primary care centers (Figure 4). Fifteen participants, representing a diverse sample from these centers (five for each one), engaged in dynamic group discussions to assess the urban indicators and to validate maps and observations of their neighborhoods. The activity consisted of three key dynamics: (i) prioritization of urban indicators through a card-based ranking exercise; (ii) analysis and discussion of photographic comparisons of urban spaces, highlighting strengths and areas for improvement; and (iii) a collective debate to identify the essential characteristics of an “age-friendly” ideal street. The World Café fostered an inclusive dialog that helped refine the project’s outcomes and highlighted critical areas for urban design improvements tailored to older adults.

The Participants’ Sample Socio-Demographic Characteristics

A total of 132 older adults participated in the survey. They were predominantly female and in the age groups between 71 and 85 years old.

The comparison of the three primary care centers’ study samples aims to show the gender distribution, age range, lifestyle, and frailty of the study participants (

Table 1. The sample of the participants by their demographic data, lifestyle, and frailty.

	Primary Care Center	Larrard	Barceloneta	Vila Olimpica	Total
Gender	W	33	40	27	100
	M	17	8	7	32
Age	71–75	13	15	13	41
	76–80	14	11	12	39
	81–85	13	13	6	32
	86–90	5	7	2	14
	91–95	5	2	1	8
Lifestyle	Active	28	32	19	79
	Sedentary	22	16	15	53
Frailty	Physical	38	32	16	86
	Cognitive	20	13	5	38
	Social	13	7	10	30

). In terms of total participants, CAP Larrard had the largest sample with 50 individuals, followed closely by CAP Barceloneta with 48, while CAP Vila Olímpica had the lowest participation with only 35, primarily due to project delays and seasonal factors affecting older adults’ participation in summertime. Across all three cases, women constituted the majority. Age distribution was consistent across the CAPs, with most participants falling within the 71–85 age range, although slight variations existed. Lifestyle analysis revealed CAP Larrard had the least active sample, with 56% active and 44% sedentary, while CAP Barceloneta and CAP Vila Olímpica showed slightly higher activity levels, with CAP Barceloneta having a larger proportion of active participants overall. In terms of frailty, CAP Larrard recorded the highest number of participants with physical and cognitive frailty, while CAP Vila Olímpica had the lowest rates of both.

3. Results

3.1. The Literature Review: The Identification of the Study Indicators

At first, a literature review was conducted to synthesize the research across various scales and to identify factors that influence the mobility of older adults. It examines both tangible variables, such as the sidewalk quality, accessibility features, and safety measures, as well as intangible factors, like perceived security and comfort. The process involves database searching, screening, extraction, and refinement. Ultimately, 66 variables were identified, from which 55 unique, measurable ones were consolidated for further evaluation. These variables were thematically organized to capture the complexity of walkability in diverse urban environments, with a specific focus on their relevance to neighborhood contexts. This review also highlights gaps in current methodologies and recommends more contextually and culturally sensitive approaches. The findings lay the groundwork for the next phase of the project, which will validate and refine these variables, focusing on Barcelona’s urban fabric and the mobility needs of older adults.

The review utilized the PubMed.gov database, focusing on publications from 2010 to 2022, the year in which the project started. The screening process (Figure 5) followed the PRISMA guidelines and involved the following steps:

Identification: Initial searches were conducted using keywords such as “walkability,” “aging population”, “urban design”, and “healthy aging”. The search was limited to peer-reviewed articles published in English.

Screening and Eligibility: Titles and abstracts were screened for relevance, resulting in 5682 papers. After removing duplicates and irrelevant studies, 146 full-text articles were assessed for eligibility. Of these, 74 studies specifically addressed walkability for older adults and were included in the final review.

Inclusion: From the 74 studies, 66 relevant variables related to urban walkability for older adults were identified. These indicators were extracted and categorized based on their type (perceptual or quantitative) and relevance to the urban context of Barcelona.

Results/Variables Refinement: After removing duplicates and consolidating overlapping concepts, 55 unique, measurable variables were selected for further evaluation. These variables were subsequently organized into six broad thematic categories—Comfort and Safety, Accessibility, Urban Scene and Landscape, Urban Tissue, Users, and Others—to structure the analysis and ensure a comprehensive coverage of the multiple dimensions of walkability as experienced by older adults. Given the broad scope of the 55 variables, a crucial step involved synthesizing and consolidating these into a streamlined set of 12 key indicators (

Table 2. A list of the 66 variables. The (*) marks the ones eliminated during the variable refinement phase.

Categories	Variables
Comfort and Safety (24)	Sidewalk completeness, suitable sidewalk width, smooth sidewalk surface *, prevention of parking on sidewalks, presence of ADA ramps on sidewalks, good conditions for pedestrian crossings, traffic-calming measures, smooth road pavement surface, increase in police supervision, pedestrian surface quality, slope, existence and width of sidewalks, material *, pavement conditions *, maximum speed, visual transparency, physical accessibility *, vehicle entrance access, crowdedness, presence of people, traffic and road hazards, street noise/acoustic model, easy access to residential entrances, pavement continuity *.
Urban Scene/Landscape (22)	Presence of pedestrian crossings, presence of sidewalks, presence of signalized pedestrian crossings, good street lighting system, pedestrian areas, existence of obstacles, existence of trees/vegetation, existence of urban furniture, street lighting quality, diversity of information signs, pedestrian strip, shade and shelters, transparency of street furniture, opportunity to sit, lighting, pedestrian signage, pedestrian priority, motorcycle parking on sidewalks, car parking, physical barriers to walking *, fence separating sidewalks from traffic, bridge/overpass connecting to services.
Urban Tissue (13)	Residential density, intersection density, land use mix, commercial floor area ratio (FAR), traffic street intersections, existence of stairs, continuity, access to public transport, cycling infrastructure, permeability, street network layout, crossings, total distance to CAP.
Urban Tissue/Mobility (3)	Access to public transport, mixed land use *, traffic speed.
Users and Others (4)	Physical ability decline *, socio-demographic characteristics *, representativeness, and targeted information *.

), each paired with clearly defined measurable variables. This consolidation focused on grouping related variables conceptually and prioritizing those that were empirically measurable and directly relevant to enhancing walkability for older adults.

Once the data were extracted, a critical methodological step involved organizing the 66 variables through an initial qualitative perceptual screening. Variables were classified based on their nature (perceptual vs. quantitative) and assigned thematic tags reflecting the urban elements or user experiences they represented. This approach primarily aimed to identify potential biases or omissions in the literature, thereby ensuring a comprehensive coverage of relevant aspects of walkability. Subsequently, these variables were grouped into five broad categories that framed the analysis and structured the data extraction process: Safety and Comfort, Urban Scene and Landscape, Urban Tissue, and user-related ones (Table 2).

Importantly, while initial discussions considered a multiscalar classification (including city, neighborhood, and street levels), this framework was not discarded but rather assumed as a foundational premise. In fact, variables at the city level were set aside as they did not provide sufficient granularity for the type of analysis required. Instead, neighborhood- and street-level variables were deemed essential and non-negotiable to ensure both relevance and comparability with the study being undertaken. This process culminated in a refined section of variables organized into five coherent categories, setting the basis for further stages of analysis.

The qualitative perceptual screening and tagging process was essential for systematically organizing the variables and verifying that the review encompassed diverse dimensions relevant to older adults’ mobility. The five categories that emerged from this process include:

• Comfort and Safety: Encompassing the pedestrian infrastructure quality, traffic hazards, lighting, and related perceptual factors.
• Accessibility: Capturing measures related to the ease of movement and barrier-free access.
• Urban Scene and Landscape: Including vegetation, urban furniture, and overall streetscape features.
• Urban Tissue: Addressing structural elements such as the residential density, land use mix, and street connectivity.
• Users: Describing socio-demographic factors and target group characteristics.

Each variable within these categories was assessed for its relevance, measurability, and potential impact on older adults’ walkability within the specific urban context of Barcelona. After eliminating redundancies and merging conceptually similar indicators, a final set of 12 unique and operationalizable indicators was established to guide the next empirical phases of the study (

Table 3. Final list of 12 indicators. Elaborated by authors.

Indicator	Description
Presence of crossings and pedestrian streets	Considers higher walkability when pedestrian crossings and pedestrian-only streets are present
Presence and dimensions of sidewalks	Considers higher walkability when the pedestrian surface is larger
Low street slope	Considers higher walkability when slopes are mild
Presence of stairs	Considers higher walkability when no stairs are present along the routes
Presence of urban furniture	Considers higher walkability when urban furniture (e.g., benches, railings) is available
Low maximum street speed	Considers higher walkability when maximum street speed is low OR considers higher walkability when the street allows only low vehicle speed
Presence of trees and shading	Considers higher walkability when trees and shading elements are present
Low street noise	Considers higher walkability when street noise is low
Presence of lighting system	Considers higher walkability when a street lighting system is present
Closeness to public transport	Considers higher walkability when public transport stops are located nearby
Presence of bicycle and electric scooters	Considers lower walkability when bicycles and electric scooters are present in shared spaces
Absence of car and motorcycle parking	Considers higher walkability when car and motorcycle parking is absent from sidewalks and pedestrian areas

).

This reduction process was not merely technical but was grounded in a thematic coherence and applied relevance. For instance, several variables related to the sidewalk infrastructure (such as presence, width, and continuity) were integrated into a single composite indicator, capturing the core element of walkable pedestrian environments. Similarly, indicators related to vehicle speed limits and the presence of traffic-calming measures were merged into a broader category representing street safety conditions.

Each of the final 12 indicators are supported by clearly defined, measurable variables that allow for systematic observation and data collection in the field. This refined set balances the conceptual depth with methodological clarity, offering a robust yet practical framework for analyzing walkability as experienced by older adults in complex urban settings.

3.2. The Survey Results: The Average Walked Distance and Urban Indicators’ Weight

Building on the selected set of 12 walkability-related variables, we developed a survey aimed at capturing older adults’ perceptions and spatial experiences within their neighborhood. The survey included a visual component—an annotated map of the study area—and twelve statements that included the indicators derived from the literature review. Participants from each CAP were asked to respond based on their daily routines, preferences, and perceptions. This approach allowed us to bridge the abstract analysis of variables with situated lived experiences, providing data that is both context-sensitive and spatially grounded. The survey resulted in two main results: a map of each study area with the most used streets by the project participants (Figure 6) and the set of indicators with their specific weight (Figure 7).

First, results can be inferred from the average walking distance calculated for each CAP. Taken together, these results offer a comparative perspective on how the neighborhood configuration and user profiles influence pedestrian mobility across the three study areas. Observing

Table 4. Average distance walked from home to CAP and in neighborhood, based on survey realized in this study.

CAP	Total Number of Routes Registered	Average Distance Walked from Home to CAP			Average Distance Walked in the Neighborhood
		Total	Active Lifestyle	Sedentary Lifestyle
CAP Larrard	224	492 m	553 m	400 m	629 m
CAP Barceloneta	238	615 m	598 m	482 m	510 m
CAP Vila Olímpica	134	638 m	707 m	664 m	709 m

, in CAP Larrard, the relatively short average distance (492 m to the CAP) suggests a compact urban layout that supports pedestrian accessibility. There is also a clear distinction in the mobility between active and sedentary individuals, with active participants covering longer distances (553 m vs. 400 m). Moving to the CAP Barceloneta, the average distance to the CAP (615 m) is noticeably longer than in Larrard, and usual routes are slightly shorter than access routes, reversing the trend seen in Larrard. The mobility gap between active and sedentary individuals remains significant, reinforcing the link between physical activity levels and route choices. Finally, in the CAP Vila Olímpica, distances are the longest, both to the CAP (638 m) and for habitual routes (709 m).

Overall, while Larrard demonstrates the highest reliance on walking, Barceloneta and Vila Olímpica show longer travel distances, probably due to the location of the reference CAP in the neighborhood. These differences suggest that environmental and infrastructural factors play a key role in shaping pedestrian behaviors across different neighborhoods.

The bar chart in Figure 7 compares the urban indicator weights by CAPs. In CAP Larrard, participants prioritize physical accessibility elements such as street inclines and the presence of benches and green spaces, emphasizing their role in making public spaces more walkable and comfortable. However, there is also a strong concern regarding bicycles and scooters perceived as potential threats to pedestrian safety. Public transport stops, nighttime lighting, street noise, and parked cars receive lower ratings. In contrast, the CAP Barceloneta bar chart reflects a different urban context where the street inclination and parked cars are not major concerns, likely due to the neighborhood’s relatively flat terrain and narrow streets with limited parking space. Survey results show a shared emphasis on mobility-related factors, such as bicycles, scooters, and vehicle speeds, mirroring the concerns seen in the CAP Larrard. Green spaces and public transport stops receive moderate and similar ratings across genders, while nighttime lighting and noise levels are consistently rated low, suggesting these aspects are not primary concerns for residents. Finally, also in the CAP Vila Olímpica, benches and seating areas together with greenery areas are highly valued. The same is true for the presence of bicycles and scooters, which may indicate the main transversal indicator for all study cases. On the other hand, unlike the other two cases, public transportation stops are rated highly, possibly due to the longer distances in the study area, making access to transit more crucial for mobility. Meanwhile, noise, parked cars, and the vehicle speed remain low-priority concerns, aligning with findings from Barceloneta.

3.3. The Field Visits and the World Café

According to the maps resulting from the survey (Figure 6), the bar chart, and the information implemented during the field visits, this study identified the most and least walkable streets based on their features and accessibility, for each case.

Among the most frequently used and walkable streets in the CAP Larrard area there were Carrer de Travessera de Dalt, Carrer de l’Escorial, and Carrer de la Granja. These streets were praised for their wide sidewalks, the presence of benches and vegetation, and accessibility features such as crosswalks and public transport stops (Figure 8). Carrer de Travessera de Dalt was highly favored for its combination of amenities and the absence of steep inclines, although traffic was noted as a drawback. Carrer de l’Escorial shares many positive features, such as benches and vegetation, but has a more pronounced incline, which some participants found manageable. Carrer de la Granja stood out for its unique inclusion of handrails on both sides, making it more accessible for those needing extra support, though it lacked vegetation, benches, and a clear sidewalk delineation.

Conversely, less walkable streets included Carrer Ca l’Alegre de Dalt, Carrer del Cardener, Carrer de Verdi, and Carrer del Torrent de l’Olla. These streets were characterized by features that discouraged use, such as steep inclines, a lack of benches, and limited commercial activity. For example, Carrer Ca l’Alegre de Dalt has a notable incline and lacks the amenities present on its parallel street, Carrer de l’Escorial. Carrer del Cardener, though quiet and featuring vegetation and some benches, suffers from bike traffic and poorly placed tactile paving, making navigation difficult. Carrer de Verdi was avoided due to steep slopes and a lack of ground-floor shops, while Carrer del Torrent de l’Olla was noted for obstructed sidewalks caused by parked cars and motorcycles, despite having wide paths and some vegetation.

During the World Café, participants highlighted the importance of accessibility features, emphasizing the need for ramps and stairways due to the neighborhood’s sloped terrain. Although streets like Carrer de l’Escorial and Carrer Verdi were praised for their wide sidewalks, pedestrian crossings, and public transportation access, they were critiqued for a lack of greenery and seating options. Noise and traffic were noted as concerns on major thoroughfares like Travessera de Dalt (Figure 8). Participants revealed a preference for active streets with commercial activity despite higher noise levels, prioritizing connectivity and utility over tranquility.

In the CAP Barceloneta area, the most walkable streets are Carrer Ginebra, Carrer de la Maquinista, and Carrer de Pepe Rubianes (Figure 6). This result does not surprise us since the orientation of the neighborhood street pattern obliges users to walk through those horizontal connections to reach the Passeig Marítim de la Barceloneta, where at the end the CAP is located. Indeed, in this study area, the CAP is very eccentric, which means that it is not located in its center but in a side area. Among the streets, the first two—Carrer Ginebra and Carrer de la Maquinista—share common characteristics, since they are both narrow streets, with small sidewalks and vegetation. Carrer Ginebra also hosts a row of cars parked on one side, which often oblige users to walk on the road, while Carrer de la Maquinista is half pedestrian. Carrer de Pepe Rubianes has the most traffic street since it is the natural extension of the Passeig Marítim, and it is the only two-way street, which also hosts bus lines.

In the flat terrain of Barceloneta, the distinction between streets for leisure and commerce was evident, as emerged during the World Café. Participants frequently chose the bustling Carrer Pepe Rubianes, despite its noise and tourist traffic, due to its wide sidewalks and vibrant atmosphere. While there is ample seating in some areas (e.g., the Passeig Marítim), inconsistencies in the urban greenery and illumination were noted. The overuse of pedestrian zones by bicycles and scooters emerged as a significant safety concern, as did the dominance of terraces that often encroach on walking spaces (Figure 9).

In the case of Vila Olimpica, the streets which were more walkable, according to the map (Figure 6), are Carrer de la Marina, Carrer Ramon Trigas Fargas, and Avinguda Icària. The three streets share characteristics of a great sidewalk width, the presence of vegetation and greenery, as well as benches. Avinguda Icària is characterized by a pedestrian central area which is largely used as a bike and scooter line. Carrer de la Marina possesses more traffic. Among all, Carrer Ramon Trigas Fargas is the most chosen alternative to Carrer de la Marina, and it shares common characteristics with friendly streets of other study areas. During the World Café, participants from Vila Olímpica praised the presence of the wide sidewalks, ample seating, and greenery in the entire study area, with streets like Carrer Ramon Trias Fargas being identified as particularly “friendly” (Figure 10). However, issues such as noise, fast-moving bicycles, and overcrowding in pedestrian areas were frequently mentioned. Participants also expressed concerns about the balance between commercial uses and pedestrian needs, particularly in streets shared with terraces and scooters.

4. Discussion

This study contributes to the growing body of research on walkability by offering a context-sensitive perspective rooted in the urban environment of Barcelona. Unlike many walkability studies that rely on standardized variables developed in suburban contexts, our findings highlight the need to move beyond fixed indicators and consider the specific urban, social, and infrastructural dynamics that shape pedestrian behavior, especially in dense European cities.

Through a combination of mapping, surveys, and participatory activities, this study identified both supporting and deterrent elements of walkability in three distinct health service areas. While the findings of this study provide rich insights into the walkability conditions of these three neighborhoods, it is essential to contextualize them in light of the existing international literature. By comparing our results with those of previous research, we aim to position the Urban +AGIL study within the broader debate on age-sensitive urban design, highlight its innovations, and acknowledge the context-dependent nature of walkability determinants.

While the initial intention was to design a set of urban indicators applicable to different case studies, this study found no universal set of variables or indices for walkability that is applicable across global cities. This limitation aligns with the conclusions of recent systematic reviews, which emphasize the contextual specificity of walkability variables for older adults (e.g., Cerin et al., 2017 [29]). In particular, those studies identified urban greenery, benches, and street furniture as key facilitators for walking in elderly populations—elements that were highly valued by participants in our research, especially in Vila Olímpica and Larrard. Our findings confirm that these micro-scale amenities foster not only physical support but also psychological comfort, echoing the observations of Rosso et al. (2013) [4] and Buffel et al. (2014) [9] in previous case studies.

Notably, this study underscores that certain commonly accepted variables—such as adapted crosswalks or the presence of benches—may lose significance in highly serviced contexts like Barcelona, where these elements are ubiquitous. In contrast, some features commonly included in walkability frameworks—such as the vehicle speed, night lighting, and noise—received low importance ratings in our study. Participants explained these ratings by noting that they generally avoid going out at night. As Barnett et al. (2017) [20] suggest, environmental barriers such as noise may impact walking only in specific settings, and sensory adaptations—like hearing aids—which can mitigate their perceived relevance. This supports the idea that walkability is not static but is deeply shaped by users’ sensory and behavioral profiles, a point also noted by Clarke and Gallagher (2013) [8].

A core finding of this study was the perception of bicycles and electric scooters as the most prominent obstacle to walkability, consistently prioritized over car-related concerns. Indeed, the aspect that most stands out as a key finding of this study is the pedestrian–wheeled transport conflict. As outlined in the World Café results, the main issues are related to pedestrian and wheeled transport intersections—specifically bicycles and electric scooters—which create significant challenges for older pedestrians and are often more problematic than traditional car-related conflicts. This diverges from earlier walkability research—such as Frank et al. (2010) [23] or Moudon et al. (2006) [6]—which typically emphasizes car traffic and street connectivity as primary threats to pedestrian mobility.

These findings reveal a paradox that some urban transformations aimed at promoting walkability and decarbonization may inadvertently generate conflicts or undermine perceptions of safety and comfort—especially among vulnerable populations such as older adults. Alves et al. (2021) [18], in their study on Porto’s historic center, had already identified this tension and emphasized the need for a clearer spatial separation between the pedestrian and wheeled mobility. This could imply the need for dedicated lanes or clearer distinctions between pedestrian and wheeled mobility paths. Our results strongly support this trend and suggest that future walkability indices must integrate indicators specifically addressing personal mobility devices (PMDs), particularly in aging-sensitive urban assessments. In this framework, this study emphasizes the importance of identifying deterrents—factors that actively discourage walking. These include the lack of a physical separation in shared spaces, the decline of active ground-floor uses, and unresolved tensions between different modes of mobility.

Street slopes and stairs were another determinant of route choices. Orography, or the area’s terrain, is another relatively important factor, as illustrated in the bar chart (Figure 7). These findings are consistent with the research by Alves et al. (2020) [17], who argue that the sidewalk inclination and elevation gain are crucial but often overlooked variables in walkability assessments. Especially in hilly areas like Larrard, the presence of ramps, handrails, and the absence of stairs became deciding factors in mobility behavior.

Another relevant point concerns public transport access, which emerged as a high-priority factor in Vila Olímpica—where walking distances were the longest—and to a lesser extent in Larrard and Barceloneta. This finding is supported by Besser and Dannenberg (2005) [22] and is further reinforced by Cerin et al. (2017) [29], who demonstrated that the built density and mixed land use influence walking behavior largely through mediating access to bus stops. Thus, while the variable “transport proximity” was originally assigned a moderate weight in our framework, the lived experiences of participants suggest it gains salience in neighborhoods with less compact configurations.

Another relevant factor was the transformation of semi-pedestrianized spaces with unclear hierarchies, which created ambiguity and discomfort for older adults. These in-between zones, neither fully pedestrian nor fully vehicular, introduced uncertainty in the right-of-way and reduced the perceived safety of walking routes.

Finally, our findings reaffirm the importance of commercial vitality and street activity for older pedestrians—not merely as a matter of convenience but as a marker of safety and psychological comfort. Many participants preferred streets with commercial activity, citing the sense of security and vibrancy they provide. This resonates with the WHO (2007) [1], which underlines how green and active streetscapes enhance social interactions and perceived safety. However, these aspects are often absent in traditional walkability indices, such as the Walk Score (Duncan et al., 2011 [26]), which prioritize the proximity to amenities without accounting for their social or perceptual qualities.

In summary, the discussion confirms the relevance of the existing international evidence, while also pointing out key gaps in widely used metrics—particularly regarding personal mobility devices, orography, and vibrancy as protective factors. The Urban +AGIL study provides a contextualized, human-centered contribution to the urban health literature, advocating for a nuanced, perceptual, and multiscalar approach to walkability assessments in aging societies. Ultimately, this study calls for a shift in focus: from merely counting walkability assets to understanding how urban design elements interact with social behaviors and evolving mobility norms in real-life, lived environments.

In summary, there are four main topics common to the three study cases that should form the basis for further reflection.

• Street safety was a paramount concern, encompassing features such as well-defined pedestrian crossings, proper lighting, and the regulated use of bicycles and scooters. Participants emphasized the need for a clear separation between pedestrian and vehicular spaces, especially in streets with platform designs.
• The adequacy of the sidewalk width and its fair use were recurring topics. Participants called for the better regulation of public spaces, ensuring that terraces, bicycles, and scooters do not dominate walking areas. Streets with uneven pavements or obstructions were flagged as problematic.
• Although some neighborhoods had sufficient benches and greenery, the need for consistent, well-maintained vegetation and seating was universal. Participants also highlighted the importance of shaded areas for rest during walks.
• Many participants preferred streets with commercial activity, citing the sense of security and vibrancy they provide. However, they stressed the importance of designing these areas to prioritize pedestrian comfort and accessibility.

5. Conclusions

This study contributes to the growing body of research on walkability by offering a context-sensitive perspective rooted in the urban environment of Barcelona. Unlike many walkability studies that rely on standardized variables developed in suburban contexts, our findings highlight the need to move beyond fixed indicators and consider the specific urban, social, and infrastructural dynamics that shape pedestrian behavior, especially in dense European cities. Through a combination of mapping, surveys, and participatory activities, this study identified both supporting and deterrent elements of walkability in three distinct health service areas.

Notably, this study underscores that certain commonly accepted variables—such as adapted crosswalks or the presence of benches—may lose significance in highly serviced contexts like Barcelona, where these elements are ubiquitous. Instead, new variables have emerged as more relevant, such as the impact of personal mobility devices, semi-pedestrianized spaces with unclear hierarchies, and the reduced activity of street-level commerce. These findings reveal the paradox that some urban transformations aimed at promoting walkability and decarbonization may inadvertently generate conflicts or undermine perceptions of safety and comfort—especially among vulnerable populations like older adults.

Indeed, the aspect that most stands out as key finding of this study is the pedestrian–wheeled transport conflict. As is outlined in the results section of the World Café, the main issues are related to the pedestrian and wheeled transport intersections (specifically bicycles and electric scooters) that create significant challenges for older adult pedestrians, which are often more problematic than traditional car-related conflicts. In this framework, this study emphasizes the importance of identifying deterrents—factors that actively discourage walking. These include the lack of a physical separation in shared spaces, the decline of active ground-floor uses, and unresolved tensions between different mobility systems. This could imply the need for dedicated lanes or clearer distinctions between pedestrian and wheeled mobility paths. The conclusions point to a future agenda in which urban interventions must be continuously assessed and refined to avoid unintended consequences. Ultimately, this study calls for a shift in focus: from merely counting walkability assets to understanding how urban design elements interact with social behaviors and evolving mobility norms in real-life, lived environments.

Barcelona’s innovative mobility policies may inadequately address the needs of the older adult population. The study results suggest that while these policies benefit many collectives, adjustments are necessary to make walkability more inclusive. Further research in other cities with similar or contrasting urban landscapes might be useful to confirm the variability of walkability factors and help develop adaptable yet effective frameworks for different contexts.