Dementia + Urban Planning

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?

A row of blue and white apartment units that all look the same.

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.

The title of the article is, Dementia + Planning: Expanding accessibility through design and the planning process.

Age friendly cities toolkit

The World Health Organization has updated their resources on age-friendly cities and communities and added a toolkit. In 2007 the Age Friendly Cities and Communities (AFCC) program was rolled out. A Global Network of Age-Friendly Cities followed in 2010. The strength of the program was an early form of co-design with older people in local communities. That is, it promoted a bottom-up process with top-down policy support.

The guide has suggestions for meaningful engagement of older people in creating age-friendly environments. It includes detailed examples of existing national AFCC programmes, and practical steps for creating or strengthening such a programme. The vision is for all countries to establish a national AFCC programme by the end of the UN Decade of Healthy Ageing (2021–2030).

The toolkit is a separate set of resources to the guide.

Front cover of the toolkit with lots of different icons depicting all the aspects of a community with trees, buildings, parks and people in an age friendly city.

The glossary lists all the words and labels used for older people and is a useful resource in itself. As with many official guides there are a lot of words and explanations about the history and ideas. The eight domains of action are the same as the 2007 version of the guide. The Framework for implementing national programmes is in section 3.

You can access all the relevant documents and information on the WHO’s National programmes for age-friendly cities and communities web page. If you want the free toolkit you will need to sign up to get it.

A Global Network of Age Friendly Cities

There are more than 1400 members of the Global Network, and looks like it will continue to grow. The network acts locally to encourage full participation by older people in community life and active ageing. The program is an important step in meeting the goal of the UN Decade of Healthy Ageing. Setting the scene for improved participation by older people benefits everyone. What’s good for older people is good for all people.

The Age Friendly Cities and Communities program puts older people at the centre and covers all aspects of life. It’s where policy meets people. The vision is that older people can transform themselves by transforming the environments in which they live, work and play.

Access and inclusion for transport in Queensland

Different government departments are responsible for different aspects of transport services and infrastructure. Consequently, not only do we “mind the gap” at the platform, we have to mind the gaps elsewhere in the system. And these gaps are sometimes just too wide for some people with disability. Queensland’s department of Transport and Main Roads seeks to overcome these gaps with their Access and Inclusion Strategy.

Queensland is a popular tourist destination and accessible tourism needs accessible travel to support this sector. Queensland is also hosting the 2032 Olympic and Paralympic Games and this has provided an extra reason to get things right.

A boy in a powered wheelchair is mounting the ramp into the Queensland Rail train. A woman stands behind him and the station guard looks on. A man with a baby stroller and boy wait nearby to enter the train carriage. The image is from the Access and Inclusion webpage.

The Access and Inclusion Strategy aims to create a single integrated network accessible to everyone. The Strategy was developed in consultation with customers, employees and partners, and it covers services, products, information and infrastructure.

The Accessibility and Inclusion Plan 2023-2024 supports the Accessibility and Inclusion Strategy. The Plan has 27 actions across three key pillars: strategy, culture and process.

The web pages for the Strategy and the Plan have a summary and links to alternative formats of the documents including Auslan and a narrated version. There are alternative language summaries and video transcripts as well. An Easy English version is missing though.

Global roadmap for healthy longevity

When we use the phrase “design for all ages” it usually means “let’s include older people as well”. How did they get left out in the first place? The concepts underpinning universal design aim to overcome this division of ages. Many research articles address the issues, but community attitudes are slow to change. The Global Roadmap for Healthy Longevity is yet another publication promoting the need to be (older) age-friendly. It takes a global view with case studies and recommendations. 

Chapter 5 of the roadmap focuses on physical environment enablers. These include housing, public space and infrastructure, transportation, climate change and digital access. There’s very little new information in this chapter, but it brings together international research for useful recommendations.

A circle of six different coloured rings each with a key actor for an all of society approach to healthy longevity.
Six key areas of collaboration are needed.

Collaboration is needed at all levels including non government and local community organisations, the private sector, researchers and families. 

One of the key recommendations is taking a universal design approach and involving people in design processes. There is more emphasis on communities getting involved in the solutions. Strategic action plans for ageing societies exist in many countries, but few are heeded. That’s because they are viewed as being for a single sector or age group. Therefore collective action is needed. 

The Global Roadmap for Healthy Longevity is not just about older people. It recognises that all ages need to be considered, for younger people will eventually get older. It is a comprehensive publication. Here is a sample of findings from Chapter five. 

Housing

“Finding 5-1: Housing that encourages independence, social integration, and mobility is a key factor in older adults’ ability to realize healthy longevity, but the availability and affordability of this type of housing are limited, especially for those with limited financial resources.”

Walkability

“Finding 5-3: Intentionally designed public spaces and built environments can play an important role in influencing healthy longevity. Creating opportunities for mobility, walkability, access to green space, and social engagement can enhance the lives of older people and reduce mortality and morbidity.”

Finding 5-4: Public infrastructure, such as sidewalks, bike lanes, and well-lit streets, can influence the usability of an area and adults’ perception of safety.”

Transportation

“Finding 5-5: Safe and accessible transportation options can give older adults the opportunity to enjoy independent mobility around their community instead of avoiding social activities and becoming isolated and lonely.”

Information and communications technology

“Finding 5-6: Access to broadband internet is integral to many aspects of society. Low-income and rural households are especially likely to lack broadband access, which greatly influences their equitable access to other resources and their ability to work remotely and stay connected to social networks.”

Global Roadmap for Healthy Longevity is published by National Academies of Sciences, Engineering, and Medicine. 2022. Global Roadmap for Healthy Longevity. Washington, DC: The National Academies Press. https://doi.org/10.17226/26144. The full publication is available for download. 

 

Our Streets: Dangerous by Design

The Dangerous by Design report from Smart Growth America has some interesting statistics about road deaths. This 2022 report differs from previous reports because it captures the behaviours of people during a pandemic. People walked more and drove less, but there were more road deaths. The report examines why.

“Seeing driving go down while deaths went up should call into question the long-held belief that traffic fatalities are inextricably linked to the amount of driving.”

Front cover of Dangerous by Design Report.

Conventional wisdom among policymakers and transportation professionals is that traffic fatalities are inextricably linked to the amount of driving. But the decrease in driving during the pandemic meant less congestion and a significant increase in speeds. Therefore more people were killed. Consequently, speed is the key factor.

Smart Growth America claims that too many transportation agencies and decision makers have been “asleep at the switch”. Their incremental changes to improve safety have not made any positive difference overall.

Those in power, “will have to unwind the deeply embedded, invisible yet powerful emphasis on speed, which is completely incompatible with safety.”

Two ambulance officers push a patient into the ambulance.

The Dangerous by Design 2022 report has several recommendations in terms of policy and design. The guest supplements provide practical experience and add depth to the report. The bottom line of the report is that we have to choose between speed and safety.

Walking and wheeling

The report has a sidebar about “walking” and inclusive language. Of course, some people cannot walk and that is why the term “pedestrian” is used throughout. People using mobility devices are considered pedestrians. However, they are not separated from people using other devices such as skateboards. Consequently, data are difficult to assess in terms of people with disability.

An engineer’s perspective

Charles Marohn writes in a guest supplement that engineers start the process by using the values of their profession. They don’t stop to consider their values might be questioned by others. It’s about standard practice. He says no-one asks questions about speed in proposed road and street designs. Engineers might claim they are not in control of how fast people drive, but Marohn questions this “excuse”. He believes they have a duty to consider it.

Accessible and inclusive cities: case study

The research team with the Mayor (standing).
Bunbury research group

Talking about universal design is all very well, but it takes collective action to make it happen. Collective action for accessible and inclusive cities requires everyone to get on board and work together. And “everyone” means governments at all levels, urban planners and designers, construction companies, contractors and tradespeople. Everyone also means citizens and this is where co-design methods come in. 

Two case studies form the basis of a research paper on two regional centres in Australia. One is in Geelong in Victoria and the other in Bunbury, Western Australia. The authors describe the collaborative and action oriented process in both studies. 

A note of caution. Many local governments have little power over developments that not funded by them limiting what they can achieve. Private and commercial developers can legally challenge any requirements beyond the building codes. 

Recommendations for both centres emerged from the research process. The key recommendation is to use a co-design and co-research process. The authors take a universal design to the whole process and recommendations. They also call for enhanced standards including mandating co-design. 

The title of the paper is, Accessible and Inclusive Cities: Exposing Design and Leadership Challenges for Bunbury and Geelong. It is open access. 

Two of the authors, Adam Johnson and Hing-Wah Chau, were speakers at the 4th Australian Universal Design Conference. Papers were published by Griffith University.  

From the abstract

This article compares research identifying the systemic barriers to disability access and inclusion in two regional Australian cities. We discuss some of the leadership and design challenges that government and industry need to address to embed universal design principles within urban planning, development.

In Geelong, Victoria, the disability community sought a more holistic and consultative approach to addressing access and inclusion. Systems‐thinking was used to generate recommendations for action around improving universal design regulations and  community attitudes to disability. This included access to information, accessible housing, partnerships, and employment of people with disability.

In Bunbury, Western Australia, a similar project analysed systemic factors affecting universal design at a local government level. Recommendations for implementing universal design included staff training, policies and procedures, best practice benchmarks, technical support and engagement in co‐design.

Universal design and local government

Three children, each a wheelchair user, are enjoying the spinner in the playground: a universal design.
Children enjoying the spinner in the playground

Here is an earlier paper from Adam Johnson who used Bunbury in Western Australia as a case study for his presentation at the UD2021 Australian Universal Design Conference. Bunbury set itself an aim, and a challenge, to be the “Most Accessible Regional City in Australia”. Adam explained how he used participatory action research (PAR) methods to meet Bunbury’s challenge. Universal design in local government means involving the people who are the subject of the research. In this case, people with disability and older people. 

PAR has three principles: 

    • The people most affected by the research problem should participate in ways that allow them to share control over the research process
    • The research should lead to some tangible action within the immediate context
    • The process should demonstrate rigour and integrity. 

Adam recruited 11 co-researchers to work with him: 6 people with disability, 3 family carers, and 2 support workers.

Local government is where the ‘rubber hits the road’. Local government is best placed to work with residents and understand the context of where they live, and it means they can be innovative with solutions tailored to local needs. 

The research project had a positive impact:

– Greater alignment between policies and practices at the City of Bunbury with universal design.
– Co design panel created informing many current infrastructure projects.
– Universal design standards adopted.
– Staff and contractors trained in Universal Design.
– $100,000 per annum allocated for auditing and retrofitting

The project was undertaken with a three year industry engagement scholarship with Edith Cowan University. The title of Adam’s presentation is, Universal design in local government: Participatory action research findings. 

 

Vulnerable citizens in floods and fires

Climate change is bringing increasingly dangerous and catastrophic weather events. Floods and fires are a regular occurrence in Australia, but not with the frequency and intensity that we are seeing now. While there are standards for building evacuations and fire risk management, these were developed without thought for vulnerable citizens. And when people need to evacuate to a communal place of safety, there is no guarantee it will be accessible.

Residents of the Northern Rivers area of New South Wales are not new to flood events. But the floods are getting worse. A major flood event occurred previously in 2017 and four researchers decided to explore the experiences of people with disability.

We found people with disability and carers are more likely than others to be affected and displaced. Their needs are more immediate and urgent than most, and their mental health is more likely to be compromised.

Road Closed signs and a barrier of a road that reaches down to a river in flood.

Their findings show the profound impact and systematic neglect experienced by people with disability and their carers. A longer term recovery period is required for people with disability with tailored supports. Consequently, people with disability should be included in flood preparations and recovery efforts.

The title of the article is, Exposure to risk and experiences of river flooding for people with disability and carers in rural Australia: a cross sectional survey. It’s not a very accessible document as the format is in two columns.

Fire safety

The NDIS aims to support people to live independently in a home designed around their disability. This usually means a step free entry and modified bathroom designs. However, little, if any, thought is given to the design of fire safety and safe evacuation in an emergency. Some NDIS participants will need extra support to prepare for and react in an emergency.

“Fire safety systems must be considered as a total package of risk management, equipment, maintenance, training and fire and evacuation drills. …Where disabled or immobile persons are concerned, the importance of the total package cannot be underestimated”

house fire photo taken at night time.

Hank Van Ravenstein outlines the role of the NDIS in his paper, Fire Safety and the National Disability Insurance Scheme. The first part relates the history of the NDIS followed by technical considerations for safety. He argues that the National Construction Code regulations don’t fully address or reflect the needs and risk behaviours of NDIS participants.

If we are to take a universal design approach, if the fire safety regulations aren’t sufficient for people with disability, are they sufficient for everyone?

Bushfire safety

As cities grow and become more compact, some citizens feel the need to “go bush”. This usually means finding a forest haven amongst the trees away from urban living. Then there are those who have always lived in the bush and wouldn’t live anywhere else. But bush living is risky and can be costly in terms of lives and property. It is particularly risky for people with disability and consequently, a different risk assessment process is needed.

Despite fire and rescue authorities encouraging people to prepare for bushfires (and floods), many leave it too late. Some are unable to understand the instructions, or unable to carry them out.

A nighttime view of a major bushfire. The bright orange and red glow of the fire is reaching into the tops of the trees.

A paper by Bennett and Van Ravenstein spells out all the technicalities of fire prevention and control. They argue for a risk assessment approach to existing and proposed buildings for vulnerable persons. The aim of their method is to provide a consistent basis for assessment.

The title of their paper is Fire Safety Management of Vulnerable Persons in Bushfire Prone areas.

There is an related paper on vertical evacuation of vulnerable persons in buildings.

Public toilets and cultural conflict

When you gotta go, you gotta go and it doesn’t matter who you are or how you identify. Historically, the use of public toilets has been studied from four different and separate perspectives. These are gender, public health, ergonomics, and the spaces people like between themselves and others. Public opinion plays a role and this makes the creation of inclusive public toilets a site of cultural conflict.

Standard toilet block in a rural area signed as Ladies and Gents.

Trans* rights are getting more attention these days and public toilets seem to be an area where public opinion plays a big part. But the trans population is not the only group that has trouble with toilet rooms.

Public toilets have been around for more than 2000 years. They are both public and intimate places at the same time. This gives rise to an emotional response to our need to eliminate and dispose of our waste. We care who we share this public yet intimate space with.

Steinfeld, Thibodeaux and Klaiman have taken up the issues with a view to solving issues by design. That is, to make these public amenities more inclusive. In doing so, it might provide some insights into making other public facilities more inclusive. The title of their research paper is, Public Restrooms: A Site of Cultural Conflict.

The research paper outlines a literature review and the qualitative research methods. The aim is to identify strategies for inclusive restroom design that is acceptable to the US population generally.

From the conclusions

The researchers note that in many parts of North America, any attempt to depart from the conventional binary women/men design will be politicised. Hence they can expect little, if any change. The conventional euro-centric gender segregated restroom is a reflection of a culture that supports a rigid idea of gender identity. Unfortunately, it neglects the realities of diverse needs.

Supporters of trans access to restrooms have focused on changing laws. However, laws do not address the whole problem. They can still face violence and abuse. The design of public toilets needs to be addressed too.

On orange door with a sign saying Unisex Toilet and baby change with icons to match.

A simple strategy for improving trans access is re-signing single user restrooms to be “all-gender”. It is an good initial first step because trans and cisgender people with additional needs can use these restrooms.

From the abstract

Public restrooms have become the major locus of conflict over trans rights. But this is only the latest manifestation of cultural conflicts related to restrooms. Historically, the restroom has been studied through four aligned, but separate, lenses: gender studies, public health, ergonomics, and proxemics.

These four lenses are both interdependent and intersectional. A review of literature paints a picture of how this conflict represents the gulf between embedded cultural values and the lived experience of a diverse population. We hypothesize that there is strong consensus on what people desire in toilet rooms, particularly regarding safety, hygiene, and privacy. However, these desires conflict with a cultural legacy based on hetero-normative values.

This hypothesis was tested through a review of research and preliminary findings from a survey that targets the intersections of gender identity, public health, ergonomics, and boundary regulation. This research leads to a holistic picture of the public restroom and situates the contemporary conflict as the result of polarized public opinion.

Demographics and ideology play an important role in forming opinions. While the public restroom is the main focus, this research improves our understanding about the larger issues. How might our built environment adapt in response to a more nuanced view of gender? How might urban spatial practices serve as catalysts for social change.

*Note that the term “trans” is used to encompass a wide range of gender identities including transgender, intersex, gender non-conforming and others.

World Cup: Accessible by Design

Major sporting events offer great opportunities to design and build inclusive infrastructure and services. The FIFA World Cup in Qatar is no exception. The Accessible by Design: Building a legacy of inclusion report sets out Qatar’s challenges and solutions.

The aim is to “ensure stadia and the entire experience, inside and outside the stadium, are fully accessible to all. This includes designing and planning for accessible hotels, transportation, tourist attractions and more”.

The policy recommendations in the report “provide solid and practical guidelines to design and redesign cities that are equally accessible to all”.

Front cover of Accessible by Design report.

Qatar has worked with organisations representing people with disability to meet their pledge to deliver the most accessible World Cup to date. This means both inside and outside the stadia – hotels, transportation, and tourist attractions. The aim is to leave a lasting legacy and a national priority for greater accessibility across Qatar.

Report and recommendations

The report is in four sections with an executive summary with a focus on urban design and the FIFA World Cup event. The first section discusses the prevalence of and disadvantages for people with disability. Five levels of accessible and inclusive urban design are presented based on the UN’s Economic and Social Affairs work.

The second section relates specifically to the World Cup with diagrams and explanations of how Qatar will achieve its aims. The third section is about what to expect at the tournament. With eight stadia all within a relatively close proximity to each other. That means fans can see more than one match in a day.

The fourth section has conclusions and policy recommendations. At the end of the tournament it will be necessary to check the experiences of people with disability. And also, whether the tournament left a lasting legacy of service and behavioural change.

The report closes with six policy recommendations. Similarly to the London Olympic and Paralympic Games, setting up an authority to continue the work is one of them. There is not much new in the report for countries that have policies on access and inclusion. However, it is good to see their aims and objectives set out in the report. While people with disability are being considered, we know that there are some other groups who remain on the outside.

The report is published by WISH and draws on the WISH 2022 Forum on Accessible Design and Health recently held in Doha.

WHO age friendly cities: does it work?

The World Health Organization’s guide to age-friendly cities and active ageing set the trend for policy in 2002. The publication, Global Age-Friendly Cities: A Guide, supports the age-friendly framework. This inspired the development of the Global Network of Age-Friendly Cities and Communities. So how successful has this age-friendly movement been?

Front cover of the WHO guide for age friendly cities.

The longevity revolution is happening now. So it is a good time to review the success or otherwise of the age-friendly movement and the WHO framework for age-friendly cities.

The WHO Guide was initially designed to be a bottom-up participatory process. The flexibility of the process enabled individual cities and communities to work on local issues. However, it hasn’t quite worked that way. As with all participative processes, it comes down to whose voices are being heard at the discussion table. And it depends on whether the city or community is urban or rural and on the resources available.

Edgar Liu has checked out Australian policies across the three tiers of government. He wanted to find out if the WHO guide and framework inspired policy making. And if it did, to what extent. In a nutshell, these policies did not fully reflect socioeconomic and cultural diversity. Also, the policy focus remains on care and support services, which conflicts with the recommendations for connecting with multiple policy areas.

The title of the paper is, The World Health Organization’s impact on age-friendly policymaking: A case study on Australia.

WHO age friendly logo of 8 petals showing the 8 domains of life.
The WHO Age-Friendly Cities Framework

Abstract

This paper reflects on whether and how the World Health Organization (WHO) inspires age-friendly policymaking across different levels of government. This is done via a case study in which we analyse the policies of Australia’s three-tiered federated government system against the WHO’s eight core age-friendly cities domains.

Findings suggest that membership of the Global Network of Age-Friendly Cities and Communities did not appear to overtly inspire the development of age-friendly policies across Australian governments.

Content analysis shows there is an overwhelming policy focus on care and support services, with little attention to cultural diversity. This reflects an outdated portrayal of debilitation in later life and a lack of recognition of how diverse circumstances impact the ageing process and corresponding support needs.

Our findings also reveal the challenges of a three-tiered federated system, where varying financial and authoritative capacities have influenced how different governments acknowledge and respond to population ageing.

Notably, local governments—the main level of implementation targeted by the WHO—are invariably constrained in developing their own age-friendly policies and may opt to adopt those of higher levels of government instead. These challenges will likely impact other resource-limited governments in responding to the needs of their emerging ageing populations.

You can read more in a related post Manchester and Brussels: A place to grow old.

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