Dementia Friendly Hospitals: An in-depth study

A hosptial room with three empty beds. It looks very clinical.People with dementia find new places and routines challenging. So when it comes to going to hospital they often experience increased anxiety and disorientation. The design of the hospital environment can have an effect on this group. That’s the finding of some new research carried out in hospitals where they interviewed patients and family members. “The voices of patients, particularly persons with dementia and their APs, are a crucial element in helping hospitals to fulfill their role as caregiving and healing facilities”.

The title of the article is, Dementia Friendly Hospital Design: Key Issues for Patients and Accompanying Persons in an Irish Acute Care Public Hospital  You will need institutional access for a free read. This is further work from Ireland on their guide to dementia friendly hospitals

Objectives: Research was conducted to investigate the impact of the hospital environment on older people including patients with dementia and their accompanying persons (APs). The article presents key research findings in the case study hospital.

Background: For many patients, the hospital is challenging due to the busy, unfamiliar, and stressful nature of the environment. For a person with dementia, the hospital experience can be exacerbated by cognitive impairment and behavioral or psychological symptoms and can therefore prove to be a frightening, distressing, and disorientating place.

Method: The findings are based on a stakeholder engagement process where the research team spent approximately 150 hr observing within the hospital, administered 95 questionnaires to patients and/or APs, and conducted 12 structured interviews with patients and APs. A thematic analysis was employed to analyze and generate key themes emerging from the process.

Results: Themes were grouped into overarching issues and design issues across spatial scales.

Conclusion: This research confirms the negative impact of the acute hospital setting on older people with cognitive impairments including dementia and delirium. The multiple perspectives captured in this study, including most importantly people with dementia, ensure that stakeholder needs can be used to inform the design of the hospital environment. The research points to the value of understanding the lived experience of the person with dementia and APs. The voices of patients, particularly persons with dementia and their APs, are a crucial element in helping hospitals to fulfill their role as caregiving and healing facilities. 


Economic arguments for UD in Housing

A line of complex manufacturing machinery used to show the complex process and number of stakeholders involved in mass market housing.Economic arguments are often seen as the most persuasive way to change the design of mass market homes. Research papers over several years have produced solid economic arguments for universal design, but they have failed in their quest. So the issues are beyond those of economics. Regardless, for those who want the research, here is a list of papers, including the cost effectiveness of home modifications (or not needing them in the first place). This is not an exhaustive list, but gives and idea of what work has been done.

The cost of NOT including accessibility in new homes This landmark article by Smith, Rayer and Smith (2008) uses complex economic methodologies to show that a new home built today has a 65% likelihood of having an occupant with a permanent disability. It is often forgotten that people with disability live in families – not alone.

A cost benefit analysis of adaptable homes by urban economist Martin Hill of Hill PDA. This conference paper was written in 1999 and shows how long these arguments have been running. The context is adaptable housing – the forerunner of universal design concepts in housing. It was prepared for the NSW Department of Urban Affairs and Planning.

Home adaptations: Costs? or Savings? A survey of local authorities and Home Improvement Agencies: Identifying the hidden cost of providing a home adaptations service. 

R&D incentives for UD in housing: Norwegian experience. This article discusses financial incentives in the context of creating change in the mindset of the house building industry.

Accessible housing: costs and gains This article evaluates the costs and gains of modifying homes

Using Building Information Modeling with UD Strategies This article develops a technical framework to evaluate the costs and benefits of building projects. 

Universal design in housing from a planning perspective  A comprehensive look at the housing landscape, an ageing population, and the need for universal design in housing.

Universal design in housing – does it really have to cost more? In a down to earth fashion Kay Saville-Smith discusses the “size fraud”

Barriers to Universal Design in Australian Housing is a short paper based on a thesis which gives an indication of why economic arguments alone are insufficient to bring about change.  


Can tourism improve walkability?

brick paved footpath with planter boxes with flowers .If local and state governments aren’t listening to residents about mobility, walkability, and wheelability then perhaps they might consider visitors and tourists with money to spend locally. But are they really interested in the extra tourist dollars? Does the local Chamber of Commerce think it’s all too difficult to create greater access and inclusion? The walkability issue isn’t just about footpaths, seating and toilets – it’s about all the links in the chain to make it happen – joined up thinking. Otherwise we end up with islands of access and inclusion. And you can’t be a bit inclusive – it either is or it isn’t. That means business, community and governments need to work in unison on the design of physical environments, customer service and tourist information. And of course the reverse of the question is, “Can walkability improve tourism?”

Accessibility and Equitable Tourism Services for Travelers with Disabilities: From an Charitable to a Commercial Footing, takes a corporate and social responsibility perspective on some of these issues. You will need institutional access for a free read – published in Corporate Sustainability and Responsibility in Tourism, where there is further reading.

A research paper from Turkey, Assessment of factors influencing walkability in shopping streets of tourism cities is also worth a read. They found that “Urban planning and design should focus on how to connect people and places together, by creating cities that focus on connectivity, accessibility, crime security, traffic safety, and comfort
and use’. 

You can find some inclusive tourism guides, magazine articles and research papers in the tourism section on this website


Playgrounds for all children

An empty wooden swing hangs over green grass.Inclusive play spaces are receiving more attention, but what equipment and design features are most suitable? Research in the US throws some light on this topic. Children, parents, teachers, landscape designers and equipment manufacturers all have a stake in the outcome. This means there are often gaps between what is required, what is available and what gets implemented. Building Playgrounds for Children of All Abilities looks at legal requirements and provides some useful recommendations. You will need institutional access for a free read. There is a useful reference list as well. 

There are several other good guides to inclusive play spaces including, Everyone Can Play published by the NSW Government.

Abstract: Schools and communities typically design and build playgrounds with little knowledge that the selected playground equipment meets the needs of children, caregivers, and teachers. In this article, the various categories of playgrounds are discussed and analyzed. The focus of this discussion includes an overview of the legal requirements and guidelines for school and community playgrounds, a description of prior research highlighting the inadequacies in currently available playgrounds, and an explanation of the trends in playground design over the years. We relate these topics to the need for universally designed playgrounds and a deeper commitment to designing playgrounds and play equipment that is empirically tested and meets the needs of all children, their teachers, and their families. By discussing practical examples and research findings to illustrate the gap between playground manufacturers and their play equipment and playground consumers, this paper serves as a meaningful resource for teachers and other stakeholders so they have the knowledge to advocate for their students with disabilities in playground endeavors. Taking recent research findings into account, we provide a vision for playground policy change.  


ICT, AI and older people

An older woman sits at a table in a room with a tv behind her.The Digital Age has brought us Artificial Intelligence (AI) and Ambient Technologies, but can people and policies keep up with the pace of development? The 5G network brings additional promises, but will designers consider the diversity of the population, especially in algorithms? A keynote paper presented by Liz Mesthenos gives a thoughtful overview of the state of play regarding this technology and older people.

It is interesting to note that the EU “appears to be keen on free access to the internet to ensure non-exclusion…” Mestheneos cautions the use of sensors used via smart phones, web cameras, etc., for family carers to monitor a relative. Ensuring they are non-intrusive and data remain private will be a continuing issue. AI products will have to ensure they are accessible as well as secure, and are not based on existing human prejudice and assumptions.

The title of her paper is, “Reflections on Older People in Relation to ICT-AI” and covers: the importance of co-creation, system usability, justice, fairness, privacy, safety, and inclusive design. A well thought out paper. But it is not readily available. Let me know if you want a copy.

ABSTRACT: Can ICT e.g. AAL, AI, Ambient Living technologies, really help the growing numbers of older people live better, more fulfilling lives? Or are these technologies primarily being developed for the interest of health and welfare systems and tech development experts? Have we genuinely listened to the needs of older people and reacted to their problems and needs, or are the driving forces behind innovation state budgetary limitations and the management of new and ever expanding problems? Even in the context of management, can these ICT technologies be effective or are they marginal to the management of living with dependency, long term illnesses and alone. Can and in what way do they help make older people’s lives more connected, meaningful and richer? Ensure that older people do not become objects, presenting technical problems to be solved, but people who have capacities which technology can help support. The presentation will concern the limitations of current approaches and suggest ways forward to genuinely support older people. 


Applying UD to organisations

A graphic showing words related to organisations.Organisational design hasn’t received much attention from a UD perspective. Using a child care centre as a case study, Katherine Mowrer takes three views: sustainable development, universal design, and disability justice. As an academic paper, it includes philosophical discussions and theory. At the end there is a good checklist (quoted below) that any organisation could use to see if they are being inclusive. The title of the paper is Organization-Based Disability Access: A YMCA Childcare Center Case Study.

This section is adapted from Equal Access: Universal Design of Professional Organizations— A checklist for making professional organizations inclusive of everyone by Sheryl Burgstahler, Ph.D. Many of the questions require yes/no/maybe/unsure answers, though feel free to expand on your answer if need be.
“Universal design (UD) means that rather than designing for the average user, you design for people with differing native languages, genders, racial and ethnic backgrounds, abilities, and disabilities.”
Planning, Policies, and Evaluation
• Are people with disabilities, racial and ethnic minorities, men and women, young and old students, and other groups represented in the organization’s planning process?
• Do you have policies and procedures that ensure access to facilities, events, and
information resources for people with disabilities?
• Are disability-related access issues and other diversity issues addressed in program evaluation plans and instruments?
Information Resources
• Do pictures in your publications and website include people with diverse characteristics with respect to race, gender, age, and disability?
• In key publications, do you include a statement about your commitment to access and procedures for requesting disability related accommodations? (For example, you could include the following statement: “Our organization’s goal is to make materials and activities accessible to all participants. Please inform organization leaders of accessibility barriers you encounter and request accommodations that will make activities and information resources accessible to you.”)
• Are all printed publications available (immediately or in a timely manner) in alternate formats such as Braille, large print, and electronic text?
• Are key documents provided in language(s) other than English?
• Are printed materials in your facility or at an event within easy reach from a variety of heights and without furniture blocking access?
• Do electronic resources, including web pages, adhere to accessibility guidelines or standards adopted by your organization, funding source, or the federal government? Section 508 Standards for Accessible Electronic and Information Technology and Web Accessibility Initiative (WAI) are most commonly used. For example, are text alternatives provided for graphic images on web pages? Can the content be accessed with a text only browser and by using the keyboard alone?
• Do you include a statement on your website affirming your commitment to accessible design? For example, you could include the following statement: “We strive to make our website accessible to everyone. We provide text descriptions of graphic images and photos. Video clips are captioned and audio-described. Suggestions for increasing the accessibility of these pages are welcome.”
• Do videos developed or used in your organization have captions? Audio descriptions? 
Physical Environments and Products
• Are there parking areas, pathways, and entrances to the building that are accessible from a seated position?
• Are all levels of the facility connected via an accessible route of travel?
• Are aisles kept wide and clear of obstructions for the safety of users who have mobility or visual impairments?
• Are wheelchair-accessible restrooms with well-marked signs available in or near the office?
• Is at least part of a service or counter desk at a height accessible from a seated position?
• Are there ample high-contrast, large-print directional signs to and throughout the facility, indicating accessible routes?
• Are telecommunication devices for the deaf (TDD) available?
• Is adequate light available?
Staff and Volunteers
• Are all staff members and volunteers familiar with the availability and use of the Telecommunications Relay Service and alternate document formats?
• Do all staff members and volunteers know how to respond to requests for disability related accommodations, such as sign language interpreters?
• Are all staff members and volunteers aware of issues related to communicating with participants who have disabilities? Do staff deliver conference presentations and exhibits that are accessible to all participants?
• Are project staff, contractors, and volunteers in specific assignment areas (e.g., web page development, video creation) knowledgeable about accessibility requirements and considerations?
• Is an adjustable-height table available for each type of workstation to assist participants who use wheelchairs or are small or large in stature?
• Do you provide adequate work space for both left- and right-handed users?
• Is software to enlarge screen images and a large monitor available to assist people with low vision and learning disabilities?
• Do you provide a trackball to be used by someone who has difficulty controlling a mouse?
• Are procedures in place for a timely response to requests for assistive technology?


Updates to 2019-2020 Conferences

Rows of orange and black chairs at a conference venue.New to this list: International Urban Design Conference, 13-16 November 2019, Hobart Tasmania. Call for presenters closes 26 July 2019 with blind peer review for accepted papers. 

Abstracts re-opened from 31 May to 14 June for the International Conference on ​Transport & Health – theme: Smart Cities. Disruptive Mobility. Healthy People. 4-8 November 2019, Pullman Melbourne on the Park.

Slips, Trips and Falls Conference 13-14 February 2020 Madrid. Call for Papers closes 31 July 2019.  Topics include architectural design, ageing, ergonomics, footwear, and safety standards as well as falls prevention and analysing accidents. Website is in Spanish and English.

International Conference on Disabling Normatives 1 – 3 October 2019, Johannesburg, South Africa. Call for abstracts closes 28 June 2019. Has an academic focus and is hosted by the Wits Centre for Diversity Studies. 

Here are the rest:

National Sports Convention has a major strand on Diversity and Inclusion in Sport hosted by Sport and Recreation Victoria. To be held in Melbourne 23-25 July 2019. Convention theme is, “Re imagining Sport: More people active with greater participation”. Registrations are open. One ticket for multiple events within the Convention.

Liveable Cities Conference, 12-13 August 2019, Adelaide. Key themes: Happiness, Health and Wellbeing, and Strategies, Planning and Design for People. 

ACAA Access Consultants National Conference, Theme Inclusion by Design: Equality, Diversity and the Built Environment. 14-16 August 2019, Luna Park Sydney. Earlybird registrations open.

ATSA Independent Living Expo: Canberra on 27-28 August as part of iCREATe conference.

AAATE 2019: Global Challenges in Assistive Technology: Research, Policy and Practice. 17-19 August 2019, Bologna, Italy. Note that Universal Design is included in this conference. AAATE is sister organisation to Australia’s ARATA. See conference flyer for more information.

Constructing our World: People, Performance, Politics 18-20 September 2019, Four Seasons Hotel, Sydney. Joint hosts are the Institutes of Building of Australia, New Zealand and Singapore. Earlybird Registrations open now.

​​International Conference on ​Transport & Health – theme: Smart Cities. Disruptive Mobility. Healthy People. 4-8 November 2019, Pullman Melbourne on the Park. Abstracts re-opened from 31 May to 14 June.

52nd AAG Conference Sydney. Coming of Age Together: New Ways of Knowing and Acting. 5-8 November 2019. Topics include social engagement, environment, design, innovation and technology.  

International Conference on Urban Health: People Oriented Urbanisation – Transforming cities for health and well-being. 4-8 November 2019, Xiamen, China. 

International Urban Design Conference, 13-16 November 2019, Hobart Tasmania. Call for presenters closes 26 July 2019 with blind peer review for accepted papers. Several topics to choose from.

World Engineers Convention – theme is Engineering a Sustainable World: The next 100 Years. 20-22 November 2019, Melbourne. Call for papers has closed.

Space International Conference 2019 on Housing: 29 November – 1 December, London, UK.  Call for papers closes 19 August 2019. Aim: to discuss recent advances and research results in the fields of Housing as well as architecture, policy studies, education, interior architecture, city planning and urban studies, social sciences, and engineering.

Florida State University AMPS Conference: Experiential Design – Rethinking relations between people, objects and environments. 16-17 January 2020, in Tallahassee. Abstract submissions close 20 June 2019  

Logo for Universal Design ConferenceUD2020. The next Australian Universal Design Conference will be held 13-14 August 2020 in Melbourne. Save the Date! A call for papers will be made in September 2019. 


Universal Design and Health

The Center for Health DesignThe logo of Center for Health Design based in California has an excellent checklist that focuses on design features specific to older people. Of course, such features will generally benefit others. The checklist supports a universal design approach to environments for ageing populations. It is not designed as a list of comprehensive specifications, but a “thought starter”. It is probably best used to guide the discussion of design teams at the outset of a project. The checklist covers Home and Community including dwellings, Healthcare and design of clinics and emergency rooms, and Workplace designs and strategies.

The checklist matrix lists the strategy or goal, design considerations for the built environment, and the universal implications (benefits for everyone). For example, the goal of ageing in place in one’s home requires (among others) features that are easy to clean and maintain. The universal implication is that it increases the suitability of housing for a wider range of users and potential buyers. The checklist has a comprehensive reference list to support the content and for further reading.




Autism and Building Design

A young girl is wide-eyed with a drooping mouth as is she is about to be unhappy.If designers are not thinking about autistic people now, they soon will be, or should be. Autistic people have the same rights to functional and accessible spaces as everyone else. In his article on Branch Pattern website, Stuart Shell gives an overview of ASD (autism spectrum disorder). He explains why building owners and designers need to include this group, and how it will create great architecture at the same time.

One in one hundred and fifty children were diagnosed with ASD in 2000. ASD can take the form of extra sensory awareness, and higher levels of anxiety or involuntary responses. However, most autistic people say they have their own way of experiencing the world – not a “disorder”. He concludes with a list of design options and different guidelines. It is a lengthy but very useful article that includes acoustics, lighting, thermal comfort and material finishes and furniture. There is a list of references at the end for further reading. What Autism Teaches Us About Design is an easy and comprehensive read on an important topic. 

As an aside, he mentions studies that show exposure to particulate matter (eg from motor vehicles) during pregnancy increased the odds of having a child with ASD.


Click-away customers

Five red balloons in a row with the title 5 common myths about accessibilityClick-away customers are not those clicking on the pages on your website. They are clicking off because they can’t navigate the pages. A neat video by Barclays Bank debunks common myths about customer complaints, costs of being accessible, access being someone else’s job, it’s too small a market for all that time and effort, and accessible design is boring design. Towards the end there is a great statement, “accessible design should work well for those who need it, and be invisible to those who don’t”. A really useful video for anyone promoting accessible customer service in our digital world, and for others wondering if it really is worth the effort. The video is captioned.