Friendly urban neighbourhoods for people with dementia – and others

Judith Davey

For 10/2/17

I have been doing some work lately on Age-Friendly Cities and Communities.  A sub-set of these are dementia-friendly environments. We have all heard about the likely increase in numbers of people with dementia as our population ages, but it is also clear that what might be good for this group will probably also be good for older people in general. An article in the Journal of Urban Design gave me a lot to think about and things to look out for as I walk around Wellington. [1]

To live at home successfully, people with dementia, not only need medical and social support but also outside environments where they can feel safe and comfortable. As the researchers say:

The spatial disorientation and short‐term memory problems experienced by the majority of older people with dementia can make each trip around the local neighbourhood a journey into the unknown. They are at great risk either of losing their way when they go out or of becoming housebound through a fear of becoming lost. Yet the social, psychological and physical benefits of confident and proficient use of the outdoor environment for people with dementia are numerous.

And the same probably goes for many of us!

The authors realised the necessity of seeking information directly from people with dementia. They interviewed people from this group, accompanied them on walks and analysed the characteristics of the local environment.

Some of the participants did lose their way on the walks, but some did not, mainly because they stayed in familiar territory and they had visual clues to help them. Losing their way happened most frequently at road crossings and junctions, when following a less familiar route, or when they lost concentration, for example when they were daydreaming or distracted by a loud noise. Participants were often startled by passing heavy vehicles or children shouting and especially by emergency vehicle sirens, causing them to become confused and disoriented. Excessive information and uneven paving were two additional causes of bewilderment. The researchers concluded that older people with dementia rely on the “legibility” of their local neighbourhoods. What does this mean?

Street layouts. Most participants showed a preference for short, narrow and gently winding streets rather than long, wide or straight streets. The former were more interesting, gave better sight lines and therefore were helpful in maintaining concentration. Streets on grid patterns had the potential to cause a loss of concentration and disorientation with too many cross roads and sharp blind corners.

Building form and style.  Participants found streets with varied architectural features more interesting than those with repetitive forms in buildings and street lay-out. Different shapes, features, colours and contrasts, such as varying roof lines, front doors, windows and gardens, were all useful tools for successful navigationt. Although participants were most likely to lose their way at road crossings and places with poor visual access, many also became disoriented on streets identical to neighbouring ones, with identical buildings and few distinguishing features.

People with dementia preferred vibrant, informal open spaces with plenty of activity, such as squares surrounded by shops, cafés and offices, and parks containing tennis courts, children’s play areas, boating ponds and so on. These were preferred to empty, open expanses of ground or formal green open spaces. The former provide interest and environmental cues which helped them to find their way around. They also present a more welcoming and safer environment.

Signage. Too many signs cause confusion. Where they are necessary they should contain simple, explicit information with realistic symbols. Participants preferred plain signs with large, dark lettering on a light background. Advertising and shop boards were considered to be extraneous and hazardous clutter. Signs perpendicular to the wall were considered very useful as they are visible from a distance. The post office sign is a particularly good example, being well established, familiar and encountered regularly.  What would be the New Zealand equivalent?

Environmental “cues”. The most useful environmental cues are practical and decorative items, such as clocks, hanging baskets and pot plants strategically placed at decision points and places where visual access ends. The types of landmarks which participants used included civic buildings, such as churches, libraries and town halls; distinctive structures, such as clocks and public art; places of activity, such as mixed‐use squares, parks and playgrounds; places or buildings of personal significance, such as a previous workplace, doctor’s surgery, a favourite cafe and so on. They could also include aesthetic features, such as attractive gardens, trees or planters and street furniture, including telephone and letter boxes, public seating and bus shelters. When such “clues” were encountered regularly they added to the “legibility” of the neighbourhood and were useful for wayfinding, particularly when located at important decision points.

When new developments are planned or existing areas regenerated, these design suggestion could usefully be incorporated. They would help to ameliorate the sense of isolation and anxiety experienced by many older people, with or without dementia, and people with other cognitive impairments, such learning difficulties, Down’s syndrome or brain damage. Other beneficiaries would be children and foreign visitors. An outdoor environment that people are able to confidently understand, navigate and use, regardless of age or circumstance, should be the ultimate goal of inclusive urban design.

[1] L Mitchell , E Burton  & S Raman (2004) Dementia‐friendly cities: designing intelligible neighbourhoods for life. Journal of Urban Design  Volume 9, Issue 1, pages 89-101.