Lynne Mitchell

The Accessibility of Public Spaces for People with Dementia: A new priority for the 'open city'

The social model of disability de-medicalises disability and politicises it as an issue of universal rights. However, the rights of people with dementia have been less strongly advocated than those of people with physical disabilities. This is particularly the case with environmental planning and design. The needs of people with dementia are now informing the design of residential homes and day centres, but the issue of accessibility to public spaces and amenities has been almost completely neglected. Many outdoor environments such as shopping centres or parks may be inhospitable for people with dementia because they are disorientating, difficult to interpret and navigate, threatening or distressing. The article reviews the literature on indoor design for dementia, reports on research investigating the accessibility of outdoor environments, and describes a new approach using virtual reality technology to enable people with dementia to identify and test outdoor design and planning improvements themselves.

Making the outside world dementia-friendly: design issues and considerations

Design guidelines for dementia care homes have, in recent years, acknowledged the important role the internal environment plays in influencing the functional capabilities and emotional well-being of people with dementia. However, although the majority of people with dementia live in the community, similar guidance does not exist in relation to the outdoor environment. To identify aspects of design that should be considered in making the outside world dementia-friendly an analysis of the literature on the needs of older people with dementia and on current knowledge of best practice for internal environments was carried out. By drawing parallels with the outside environment this paper demonstrates that design solutions do potentially exist which would enable older people with dementia to continue to negotiate and use their local neighbourhoods. Familiarity, legibility, distinctiveness, accessibility, comfort, and safety all appear to have a major influence. Small street blocks with direct, connected routes and good visual access, varied urban form, and architectural features, and distinctive, unambiguous environmental cues could enhance successful orientation and wayfinding. Services and facilities within walking distance with adequate seating, lighting, shelter, and well-maintained, smooth, level, plain paving would ameliorate attending problems of physical frailty. The authors are now empirically testing these initial findings.

Outdoor wayfinding in dementia

We aimed in this study to investigate (1) outdoor wayfinding performance of people with dementia; and (2) which features of the outdoor built environment are used in wayfinding by people with dementia. We observed 13 older subjects with confirmed dementia and 10 controls on outdoor walks.Two accompanying researchers recorded performance in wayfinding, built environment features and use of these features in wayfinding. Results showed that people with dementia performed worse on wayfinding, even in familiar areas, but that they attended to similar features of the built environment and made equal use of features such as signs in wayfinding. Research that investigates the built environment for people with dementia is feasible and may help guide planning policies likely to enhance independent community living for this group.

Neighbourhoods for life: Designing dementia‐friendly outdoor environments

Design for dementia has, to date, focused on the internal, generally institutional environment of care homes and dementia care facilities. Yet the majority of older people with dementia live at home, around one third of these on their own. Unless outdoor environments are designed to help older people with dementia continue to use their local neighbourhoods they will become effectively housebound. This paper presents the findings of a three‐year research project conducted by the WISE (Wellbeing in Sustainable Environments) research unit of the Oxford Institute for Sustainable Development at Oxford Brookes University. The researchers were funded by the EPSRC EQUAL initiative to examine how the outside environment could be made dementia friendly. This unprecedented research investigated the perceptions, experiences and use of the outdoor environment by older people with dementia and identified design factors that influence their ability to successfully use and negotiate their local neighbourhoods. The research found that dementia‐friendly outdoor environments are places that are familiar, legible, distinctive, accessible, comfortable and safe. The findings have enabled the researchers to provide some preliminary recommendations for designers, at all scales from urban design to the design of street furniture, on the criteria to consider in developing dementia‐friendly urban areas.

Dementia‐friendly cities: designing intelligible neighbourhoods for life

This paper presents findings from research exploring ways in which the design of the outdoor environment affects the ability of older people with dementia to understand and navigate their local urban neighbourhoods. The paper establishes the importance of legibility for older people with dementia in using and enjoying their local neighbourhoods. It also identifies design features that make an area legible for older people with dementia, such as the character of street networks and the presence and type of landmarks. By focusing on designing urban areas that are explicitly easy to understand, navigate and access, the findings are relevant to all members of society.