Dementia is a medical diagnosis that needs consideration beyond that of health care. Living with dementia is just that – living. Urban planning has a significant role to play in supporting people with dementia to maintain an active life in their neighbourhood. Samantha Biglieri’s magazine article on dementia and planning provides some useful advice.
Around two thirds of the population with dementia live in the community not a residential care setting. How can planners understand and meet the needs of this group?
Dementia is diverse
Dementia is an umbrella term to describe a set of symptoms that affect memory, visual perception, judgement and ability to sequence tasks. People who are neurodiverse or have an intellectual disability, also have similar experiences. When added together this becomes a significant portion of the population needing consideration in urban planning and design.
Designing urban settings for people with dementia provides benefits for others as well. For example, we all appreciate good wayfinding design with the use of landmarks and signage.
The importance of wayfinding
Getting lost and not knowing your way home is a common fear for people with dementia. When intersections and suburban houses look the same it becomes easier to get lost. Based on a UK study, briefly Biglieri suggests the following:
A short, irregular grid pattern of streets to create identifiable intersections and allow residents to visualize their travel path.
Streets with ample space for pedestrians with wide buffer zones between pedestrian paths, cycling paths and roads;
Variated architectural styles within the same development, mixed land-use, designs incorporating diverse styles of street furniture, public art, and vegetation to provide unique landmarks for improved navigation;
Signage that uses textual information (‘5 minute walk to the library’) and realistic photos (instead of icons, which can create confusion).
Development of memorable landscape features, open public squares, and community facilities.
Population ageing and the design of the built environment are receiving more attention. As with many aspects of inclusive design, it’s the small details that make a difference. Colour and colour contrast is one of those details for older adults.
Visual perception changes for many people as they grow older. So what colours and contrasts are most helpful? Two researchers found some answers.
The researchers found that vision loss and changes in visual perception are linked to disorientation in the environment. Disorientation can increase anxiety levels and impact wellbeing. Suggestions for improved orientation include:
Flooring that contrasts with walls so they don’t blend with each other
Alternate colours of floor coverings to indicate different purposes for each room
Floor tiling free of glare and shine
Door furniture should contrast with doors
Contrast between stairs and walls
Mono-coloured interiors can hinder orientation and identification of architectural elements. However, too many colours can overstimulate sensory perception. People who lose the ability to see bright colours, yellows and pastel colours appear white. Shades of blue, green and purple are seen as grey.
The paper includes detail of the study and includes images demonstrating the different colour choices. Some of it is related to residential care, but the findings are also relevant for individual homes. The discussion section makes links to human-centred design and universal design.
Colour is a powerful tool that can enhance the aesthetics of a design and help older adults feel independent and safe.
Moving in space is a multisensory experience. People use most of their senses such as sight, hearing, smell, and touch in addition to moving their bodies. How we feel indoors depends on the indoor climate, lighting, surface colours, air quality, floor plan, and furniture layout.
Studies show that the materials and colour of products have an impact on how we navigate a space, how we feel and, in some cases, they can even have healing effects. We investigate the association between colours in the environment and the orientation of older adults in living spaces.
We found colours have a significant impact on orientation in space and can be an effective tool for spatial orientation. Warm colour tones such as yellow, orange, and red are preferred over cold ones. Red tones are more easily recognizable for older adults who have a loss of colour recognition.
Colours and contrast in indoor environments help stimulate brain function, shorter reaction times and the perception of space.
Most of the research and about accessible transport focuses on people with physical and sensory disabilities. But people with anxiety conditions experience mobility challenges as well. Consequently, they adapt or restrict their movements to minimise anxiety triggers. Sometimes the trigger can begin before leaving home when information about the trip is lacking or inadequate.
Not much is known about the travel behaviours of people with anxiety conditions, but they are complex and varied. However, active travel in familiar surroundings lessens the impact on their anxiety.
People with anxiety disorders can be restricted in their mobility because of their concern about having an anxiety attack away from home. This can be as a driver or passenger in a car, travelling by public transport and even going on foot.
Anxiety disorders take many forms: panic attacks, fear of open spaces, fear of social embarrassment, and specific phobias such as fear of dogs. The researchers look at these and related cognitive conditions as well as different modes of transport triggering anxiety.
It’s complicated
While some reduced their anxiety triggers by driving a car, others experienced higher levels of anxiety as a driver. That also means that for some, catching a bus is preferable, while for others this raises anxiety levels. One of the key factors is the sense of being in control of their situation. Anxiety levels for most interviewees are increased when more than one travel mode is needed
Staying in familiar environments was an important coping strategy for most interviewees. Travelling with a family member of friend also helped. Taking a universal design approach to make transport systems, information and infrastructure can help mitigate anxiety levels. Knowing what to expect and when provides a the necessary sense of control.
Co-design processes should include people with anxiety disorders as well as people with physical and sensory disabilities.
From the abstract
People with anxiety disorders may encounter anxiety triggers when (planning to) travel(ing) to a destination. This affects their ability to actively participate in society.
In-depth interviews were held with 40 Dutch adults which revealed that most interviewees experience a mix of problems in using various transport modes. Interviewees often experience the feeling of being locked up and not being able to escape as anxiety triggers. They perceive the mobility system as complex and overwhelming, while mobility-related information can trigger panic attacks or lower respondents’ stress level.
Coping mechanisms include: avoidance of transport modes; avoidance of highways, bridges, tunnels; remaining in a familiar, predictable environment; asking for social support when travel is necessary; and searching for adequate travel information to use before and during travel.
Coping with anxiety disorders and mobility-related problems impacts on professional life, including job switching and job relocation. It is almost impossible to develop a ‘one-size-fits-all’ approach to alleviate this population’s problems. We end with transport interventions that could benefit people with anxiety disorders.
This study brings to light some of the hidden barriers to mobility that are experienced by people with anxiety disorders. It adds to the literature on barriers experienced by people with physical and sensory impairments.
Population ageing is a global phenomenon and the policy response is to focus on aged care and congregate living. The majority of older adults live in ordinary neighbourhoods, in ordinary homes. This policy blind spot means that anything to do with ageing is seen as a health or care responsibility and not an urban planning one. We need places and spaces for all ages and that means planning policy has to catch up with demographics.
It’s likely that ageist stereotypes underpins the policy blind spot. The World Health Organization’s Age-Friendly Communities Framework covers all aspects of life. Assumptions based on ageist stereotypes might also be why education is not on the WHO’s list.
Image: Eight Domains of Age-Friendly Cities by WHO.
An article in Rethinking the Future briefly covers the issue of population ageing from a global perspective. High income countries are reaching the peak of their population ageing where up to 30 percent of the population is over 60 years old.
Making cities age-friendly is everybody’s business. It is the business of policy, planning, housing, transport, social services, corporations, small business, etc. The article introduces three guides for age-inclusive cities and public spaces.
The Alternative Age-friendly Handbook for the Socially Engaged Urban Practitioner discusses actions such as mapping, auditing, fixing and collaborating.
Age-Inclusive Public Space is a book that documents interaction with 19 practitioners – architects, geographers, psychologists, and social scientists. Each has a view of designing, using and transforming public space to be more inclusive.
Shaping Ageing Cities focuses on 10 European cities facing ageing populations. This report looks at the built environment, housing, mobility and digital environments.
The article concludes by saying cities will have to adapt to changing needs with inclusivity – age-inclusive design practices. There is a short reference list at the end.
Social media posts rely on hashtags and images so it’s important to present them in a way that everyone can access. Access Central has two useful posts about digital accessibility: one about using CamelCase and the other is image descriptions. Of course, making online social media content accessible makes it easier for everyone to use.
CamelCase hashtags
A hashtag is a way to reach more audiences on social media, and most people use all lower case letters in their identifier. When the hashtag is multiple words strung together, it makes it difficult to read and interpret. For example, #universaldesignaustralia”. If this is written in CamelCase, it becomes #UniversalDesignAustralia”.
CamelCase is named after the way its capital letters protrude like a camel’s humps.
Camel Case helps people with vision impairment and people with dyslexia.
Using Camel Case shows consideration for readers especially people who use screen readers, and people who are neurodiverse. It makes technology more accessible for everyone.
Image descriptions
Images are an important part of social media posts, so it’s important that everyone has the chance to benefit from them. That means, people who are blind or have low vision need a text description of images. This is referred to as alt-text, or alternative text. Screen readers access the alt-text descriptions and read them out to the user.
The description of the image will depend on the purpose and context of where an image appears. For example, a photo on a dating app has a different context and purpose than that same photo on a book cover.
Some social media platforms prompt you to apply a description of your image when you upload it, which is a useful reminder.
Applying alt-text
Using examples, AxessLab has a useful guide on writing meaningful descriptions. The key is to keep it relevant and concise. A sighted person will glance a photo and it is that glance that you should try to convey.
Screenshots of text are also images and therefore all the text should be repeated in the alt text description. Avoid beginning the alt-text with “image of…” or “photo of”. The screen reader will say “image image of…” And remember to put a full stop at the end so the screen reader knows to complete the sentence. It makes for a more pleasant reading experience.
Descriptions of images are also picked up by search engines, so it is worth taking an extra minute to write a description. The AxessLab guide to alt-text is full of good tips.
The ideal pattern and symmetry of the human body underpins Vitruvian ideals for architectural design. Three architects challenge this notion as outdated because it fails to account for human diversity. Their discussion paper takes us from the Vitruvian to the variable body and the role of universal design.
“The architectural module has long been associated with the concept of measurement, where standardisation of the human body is used to define absolute modularity.”
Image is of the classic Vitruvian Man by Italian artist and scientist Leonardo da Vinci.
The Vitruvian concept reduces the human body to standard measurements to create ‘human scale’ for designing space. The variability of the human condition is contrary to this notion.
The architectural ‘module’ is a concept linked to measurement. It is associated with the scale of the human body which defines proportions and how people interact with space.
The authors discuss the creation of a module to account for the variables of the human body – to make variability the foundation of the module. Their paper refers to case studies with photos of where designs exclude people.
The quest for best solutions is apparent in the continuous updating of regulations and tools for accessibility. Integrating disability access standards with universal design is a more inclusive approach to design. The universal design element accounts for human variability in practical, social and ethical ways.
The drawing of the Vitruvian Man above illustrates the idea that the dimensions of the individual limbs of a human follow mathematical laws. Therefore, buildings should also be as well-proportioned and well thought-out as humans themselves. This theory it assumes everyone has the same body size and shape, which of course, is not the case. However, elements of Vitruvian thinking continues to reside in the myth of the average human being.
From the abstract
The architectural ‘module’ is about the measurement and standardisation of the human body. This narrow view of the module’s applicability is problematic, particularly in processes of environmental accessibility and inclusion.
This paper critically explores the limits of the traditional measurement module, rethinking the concept of modularity to account for physical and perceptive diversity. We aim to promote social inclusion and universal design in architectural projects for people.
The paper concludes that the evolution of the concepts of the module and the human being requires a revision of their very meanings, calling for a more inclusive approach to design and planning in our contemporary world.
There is an expectation that everyone will be self-reliant and keep up with the latest technology. But what happens to people who don’t keep up or can’t? Digital technologies have quickly found their way into pubic transport systems. But the digitisation of public transport can lead to unequal access.
We need to broaden the conversation from accessibility to inclusion. It has to go beyond people with mobility and sensory impairment captured by access standards. The digital divide is too complicated to be addressed by a single solution.
According to recent research, there are multiple groups of individuals who are likely to be impacted by the digitisation of public transport. If individuals experience difficulty or can’t get support, they may stop using public transport altogether. But it is these groups that often rely on public transport the most. So, what can be done to mitigate this?
A team of researchers in the Netherland set about finding some answers. Their study found more than one answer was needed, and that they needed to complement each other. They uncovered fourteen measures, categorised into five perspectives. Briefly they are:
Design – strive for universal design
Educational- provide courses
Persuasive – raise awareness
Social – provide non-digital alternatives
Governance – adopt a long term approach
The research paper explains these five perspectives in more detail using the fourteen different measures. Not all measures need to be enacted by all stakeholders in the transport system. Clearly, it depends on what part of the system people are working in. However, universal design is the underpinning perspective.
A focus on an inclusive design from the start showing the added value of digital products and services is needed. In addition, providing courses, specialist products and non-digital alternatives contribute to fostering a more inclusive public transport system. The role of public transport staff ought not to be underestimated by public transport authorities. Workers at the interface between the system and users play a key role in the digital transition.
Last but not least is the governance of digitalisation in the sector to mitigate unequal access. Nevertheless, there is only so much that the transport sector can do. Tackling systemic issues that underlie digital barriers like poverty and low literacy is crucially relevant.
From the abstract
Digitalisation is making its way into public transport (PT) services. Policy approaches to ensure that such services remain inclusive are at best fragmented, at worst non-existent. This study looks existing initiatives and lessons learnt in the transport sector, and takes inspiration from other fields with a more mature understanding of digitalisation.
Twenty-two experts working either in the PT sector or in other sectors such as healthcare and public administration were interviewed. We conclude that there is no one-size-fits-all, but a series of complementary strategies to address digital inequality.
A focus on an inclusive design, specialist products and non-digital alternatives are the basis of a more inclusive PT system in the era of digitisation.
The role of the public transport staff is essential in digital transformations. Acknowledging the issue of unequal access to PT due to digitalisation at a decision-making level is essential.
While the present study was conducted in the Netherlands, the presented measures can be applied in other countries by stakeholders working on inclusive digital transformations in (public) transport services.
Many studies use research methods that are not designed to enable everyone to participate. This means only some people get heard and for others, researchers aren’t hearing them. Whether it’s academic research or a workplace survey researchers could be missing out on valuable information. Cathy Basterfield makes this point in her short article on who gets heard in research methods .
Co-design processes are another form of research – action research. But will that process include people with intellectual, physical and sensory conditions? If there is a reading component, will everyone be able to read and interpret written information?
Basterfield lists some common problems with surveys: use of difficult vocabulary, imprecise response options, and ableist language or concepts.
People who need Easy English find it confusing to be asked to read a statement and rate their agreement on a scale. They prefer to be asked a direct question.
Expecting every person to have the ability to access websites is another barrier. 25% of Australian adults are digitally excluded according to Basterfield. Some only have a phone and completing surveys requiring text is difficult at the best of times. Basterfield’s tips to help make sure everyone can understand your information:
add prefaces to increase precision or explain context
Policy makers have been talking about population ageing, ageing-in-place and age-friendly communities for several years. But has there been any progress? The focus is still on residential care homes and this is the policy blind spot. Most older Australians are living in their own homes. So how do policies support them? And what about renters?
Three housing researchers analysed 85 policy documents against the World Health Organization’s (WHO) guidelines on age-friendly cities. They found these policies reflected outdated views of older age. That’s because the policy focus in on care and support services. This means less attention to housing, transport, walkability and cultural diversity.
Most older Australians aren’t in aged care – they are living in the community.
Policy blind spots mean they live in communities that aren’t age-friendly.
Being age-friendly for older people means age-friendly for all ages.
The research also reveals a failure to recognise the diversity and impact of the ageing process. In particular, is the lack of recognition of diverse cultural needs.
“There is almost a complete blindness to their impacts on ageing and other social determinants of health.” Regardless most older Australians want to live where they are.
In another study, researchers asked what motivates older homeowners and renters to age where they are or to relocate. It seems older renters are not given a fair choice. For homeowners, family ties matter.
Owners with children living nearby were more likely to want to stay. They might then have a reason to call on their housing wealth and become the “bank of mum and dad”. Renters, however, want the same choice but face the most disruption. Many had to move out of their neighbourhood to find a place to rent.
This is another area where policy change is needed and for many, social housing is the answer. However, social housing is in short supply.
There’s a glimmer of hope on the horizon with the new Livable Housing Design Standard. This mandated Standard in the National Construction Code provides for accessible features such as a level entry into the home. It will support many more people to age in place and reduce the need for costly home modifications.
While it will take many years for new accessible homes to make an impact, it does mean that rental housing will be included in mainstream housing stock. However, states and territories are showing reluctance to adopt this essential Standard in the face of industry lobbying. But none of us is getting any younger.
See CUDA’s short online course which provides all the technical detail for implementing the Livable Housing Design Standard.
Applying universal design principles to playgrounds means that more people will use them. That’s what a study of three playgrounds in the United States found. Two were standard playgrounds meeting ADA standards, and one was universally designed. Result? Not only did the universally designed playground receive higher use, there was also more physical activity overall.
There are many types of disability which means definitions of universal design are open‐ended. Consequently the outcomes are difficult to measure quantitatively, but not impossible. At least the move to make playgrounds more accessible has shifted assumptions that universal design is limiting.
100% of the elevated play components that are typically part of a modular play structure must be on the accessible route. But ADA standards require only 50%.
The researchers set the benchmark for universal design as going beyond the minimum ADA requirements. Doubling the ADA requirements became one of the measures. So where the ADA requires 50% of play structures to be an an accessible route, a universally designed playground requires 100%.
The three playgrounds in the study were of a similar character. Each had equipment of the same type and manufacturer, and the surfacing was the same including the colour.
The main aim of the research was to evaluate the outcomes of playgrounds designed using universal design principles. The secondary aim was to explore the physical activity levels in activity areas in parks and playgrounds.
What they found
The findings support the hypothesis that applying universal design principles can result in higher rates of playground use than those only meeting ADA standards. This counters the notion that such playgrounds are only for those living with a disability. The universally designed playground in this case study was found to be attractive to all users, It offered the same level of fun and challenge for children. The additional playground activity lead to increased physical activity in other areas of the park.
Another finding was that adults used the playground zones more than the researchers expected. Making them more comfortable for accompanying adults was the key. This last point is something that the Australian Everyone Can Play Guideline factored in from the beginning. Playspaces are for everyone regardless of age.
This study compares the impact of universal design on three playground environments, one of which was universally designed. While universal design principles are increasingly used in playground design, most prior work has focused on people with disability. This study explores the impact on all users regardless of their age or disability status.
We used a tool that records observations in three playgrounds and compared use and physical activity in the playground environments. User location and characteristics were recorded on a plan map of the park and the playground. The data were collected from 70 randomized observation periods per park (210 total for the three parks) recording 12,520 total users.
While the total user counts were similar across the three parks, the universal design playground showed 82% more users than in the mean of the comparison playgrounds. The study also evaluated the place‐based effects of park elements on the intensity of park use and physical activity.
The playground areas produced 46% of park use, with the highest percentages of active use (29.2%) in the parks as a whole demonstrating the contribution playground environments make to overall park use and physical activity.
Caregiver perceptions of inclusive playgrounds
Interviews with caregivers revealed that they thought inclusive playgrounds promote physical and social accessibility for children with disability. They encourage social interaction and friendships among children with and without disability.
This research explored the caregivers’ perceptions of children’s social and physical accessibility in inclusive playgrounds. We conducted 11 in-depth interviews with caregivers regarding their perceptions of the accessibility and use of an inclusive playground by children with disabilities and how they perceive interactions between children with and without disabilities while using the playground.
From the interviews, two major themes emerged. The first was physical accessibility, with three minor themes emerging: a) safety and physical accessibility; b) sensory and cognitive safety; and c) variety and options. The second major category was social accessibility, with two minor themes: a) social interactions; and b) building friendships and practicing social skills.
Overall, the participants described the inclusive playgrounds as safe places that include varied play equipment. It encouraged children with and without disabilities to play together, interact verbally, and build immediate friendships.
The findings highlight the importance of inclusive playgrounds as a starting place for enhanced community relationships. We suggest conducting further research that focuses on children’s perceptions including a broader range of children with varying disabilities.
