Pedestrian slips, trips and falls

The UK has an ambitious target that 50% of journeys are walked or cycled by 2030. However, for some groups the quality of footpaths is a major deterrent to walking. According to a Living Streets report, 48% of older adults say they would walk more if footpaths were better maintained. Their fear of slips, trips and falls is enough to put them off. And there is a health cost for this – not just the falls, but the lack of incidental exercise.

The number of trips and falls due to poor footpath maintenance is difficult to establish due to lack of data. Living Streets has done their best to gather what information there is to find out the state of play.

Hospital admissions and insurance claims are two obvious sources of information, but even this is patchy.

Front cover of the trips and falls report showing a man walking on a footpath using two walking sticks.

Pedestrian falls happen to people of all ages, but as people age they are more likely to fall and to sustain an injury. As a consequence they are more likely to find themselves in institutional care.

One finding is that the number of hospital admissions from pedestrian falls was three times the number from pedestrian-vehicle crashes. So, if we had better data on pedestrian falls, it could change the priorities for road maintenance spending.

The Living Streets report uses 10 observational case studies to gather more information on footpaths and falls. In the UK vehicles are allowed to park over kerbs onto the footpath. This not only blocks the path of travel, it degrades the quality of the footpath. Local authorities had different ways for people to lodge complaints about footpath maintenance.

Can things be improved?

The bottom line is that budgets decide priorities, but whose budget? In the UK, falls cost the national health service more than $2.3b per year. This figure is set to rise as the population ages. However, the focus of this cost is falls indoors and unreported falls outdoors is still a problem. Using proxy figures, Living Streets estimates there could be more than one million outdoor falls among older adults each year.

The role of road strategies and plans

In the UK, the Highways Asset Management Plan allows for local authorities to claim they they taken reasonable care to make sure the road was not dangerous to pedestrians. Is this still valid in 2024? The focus on the cost to highways is not accounted for in the cost of hospital and social home-based care. Both these costs are borne by local authorities yet there is no connection between the two.

The title of the Living Streets report is Pedestrian Slips, Trips and Falls: An evaluation of their causes, impact, scale and cost. There are several suggestions on how matters can be improved. The three key ones are: Standardise data collection, Integrate costs of transport and health budgets, and Provide prompt treatment after a fall.

Evaluating cognitive accessibility

Taking a cognitive perspective to architectural design is something architect Berta Brusilovsky Filer is passionate about. So she has written a book about it, Evaluating Cognitive Accessibility. Her free book is open access with the help of La Ciudad Accesible with the hope of reaching more people.

Cognitive accessibility is a fundamental aspect in the design of public spaces in the urban environment. At last this topic is receiving more attention in schools of design. The concept takes in easy reading, spatial orientation, signage and processes of interaction.

We rely on our brains to process information to make sense of the environment around us, but we don’t all process information in the same way. Consequently, if we design in a way that assists attention, perception, memory and problem solving, everyone benefits. Reducing cognitive load (too much going on) and maximising comprehension are key principles for independent movement around urban environments.

The book draws on the disciplines of architecture, social science and neuroscience, and presents an evaluation methodology for designers. However, it also provides a recent history of neuroscience and the role our brains play (or not) in making sense of things.

Lots of examples and photographs enhance this PDF publication. The chapter on recommendations covers the many elements of spatial orientation. The concluding chapter addresses the importance of involving people with cognitive conditions in the design process.

The full title of the free book is Evaluating Cognitive Accessibility: Scientific keys to strengthen the role of the evaluator with functional diversity.

Radical inclusion for urban transformation

Victor Santiago Pineda reflects on the Burning Man community which recognises that everyone has something valuable to contribute. It challenges the idea that some people are worth more than others. This in turn introduced him to the concept of radical inclusion. Pineda discusses this concept in relation to cities and Amartya Sen’s Capability Model.

Much of the chapter covers well trodden ground with the seven principles of universal design and more statistics to show the imperatives of inclusive practice.

A cityscape with a foreground of parkland and woodland.

Can we universally design a whole city?

Pineda relates his conversation with Kat Holmes the inclusive design champion at Microsoft. In her book she talks of the “Mismatch” where people who design society determine who can participate and who’s left out.

The tail ends of the population bell curve become invisible when governments aggregate figures. It’s at the local government level where planning is more nuanced with more of a focus on “outliers”. They are in a better position to take a universal design approach to their plans and actions. By definition, national policies are played out at a local level. That is, in communities where people live, not in a national or state policy document.

An easy to read chapter that includes discussion on climate change and examples and images of successful urban transformations.

The title of the book chapter is Radical Inclusion: The Key to Urban Transformation.

From the abstract

Fifteen percent of the global population has a disability, which will only increase with population ageing. Half of the world’s population live in cities and this is where we need to promote inclusion to address a rapidly changing demographic.

Disability is becoming increasingly common and cities must be transformed to be inclusive of everyone. The Capability Model argues that disability is created by barriers in the social environment and therefore requires social change. When barriers exist, inclusive communities work to transform the way they are organized to meet the needs of all people.

The radical inclusion is a framework aims to eliminate barriers that hinder individuals and communities from reaching their full potential. It goes beyond full participation to create inclusive systems that promote equity and resilience. Their aim is to remove barriers that perpetuate poverty, inequality, disempowerment, isolation, and exclusion.

Building the inclusive city

Front cover of the book.

Most academic writing about inclusion, disability and urban design is based on Western culture and traditions. Building the Inclusive City, an open access book, covers a recent history of disability in city planning and the cultural context of a middle eastern approach. It brings together social sciences, politics and disability studies for an integrated approach to policy. There are three underpinning themes are:

  • disability research needs a contextual position
  • access and inclusion is both local and global
  • planning education should apply a disability lens to the field
Victor sits casually and smiles at the camera. It looks as if he is sitting in a wheelchair.

The book by Victor Santiago Pineda is downloadable in full or by chapter. It’s good to see this important book has free access. Pineda is based in California.

The full title of the book is, Building the Inclusive City Governance, Access, and the Urban Transformation of Dubai. Published in 2020.

From the introduction to the book:

This book is an anthropological urban study of the Emirate of Dubai, its institutions, and their evolution. It provides a contemporary history of disability in city planning from a non-Western perspective and explores the cultural context for its positioning. Three insights inform the author’s approach.

First, situate disability research in a particular place. Second, access and inclusion forms a key part of both local and global planning issues. Third, 21st century planning education should apply a disability lens to the empirical, methodological, and theoretical advances of the field.

By bridging theory and practice, this book provides new insights on inclusive city planning and comparative urban theory. This book is a story of how equity and justice are central themes in building the cities of the future and of today.”

Picture of towering buildings in the Dubai skyline with river in the foreground
high rise buildings in Dubai

Editor’s note: I travelled to Dubai in 2015 and found much of the new infrastructure very accessible. Air conditioned bus stop shelters were a nice surprise. 

Socioeconomic benefits and costs of universal design

Access and inclusion are considered a “good thing” until someone asks, “what will it cost?” Rarely does anyone ask “what does doing nothing cost?”. Many of the benefits are on the social scale, but are difficult for orthodox economists to measure with their current tools. So what to do about it? A report from Norway looks at studies of the socioeconomic benefits and costs of universal design and accessibility.

There is a risk that a disproportionate emphasis is put on the costs and benefits of universal design rather than its broader societal benefits.

Part of the front cover of the universal design and socioeconomic analyses report. It shows a blue city tram with a person about to board.

The Nordic nations are really keen to implement universal design policies. The high priority that Norway gives universal design makes it an international leader. Other Nordic countries are yet to show the same commitment. The report maps international socioeconomic analyses and related analyses. Although using different methods, the studies emphasise cost-benefit analysis.

Why do an analysis?

Cost-benefit analyses are commissioned for different reasons. There are four main types:

1. regulatory impact assessments to analyse the potential socioeconomic consequences of new legislation and regulation related to universal design or accessibility;
2. business case studies of the profitability of investing in universal design and accessibility;
3. cost-benefit analyses as part of an assessment of reasonable accommodation, primarily with regard to discrimination legislation; and
4. research projects examining the effects of accessibility measures in general, or of specific measures, or their benefit to different target groups.

What do they look at?

Most of the analyses are about housing and the built environment with a focus on legal access requirements. The studies mainly focus on the consequences in terms of participation, employment, risk of falls, and health benefits for people with disability.

Street scene of Oslo showing footpath dining and 2 cyclists.

In the transport sector, studies mainly looked at travel time and willingness to pay more to improve accessibility. Business case studies dominate the field of information and communication technology.

Costs are usually easier to measure in monetary terms than benefits. Assumptions based on hypothetical reasoning, such as accessibility results in increased employment, lacks evidence.

From the conclusions

Many studies indicate there are significant benefits for people with and without disabilities. However, evaluating these benefits against quantifiable costs entails other variables.

Regulatory impact assessments of new legislation lacks data for calculating different effects. Specialist consultancy firms often carry out these assessments as government staff lack expertise.

In other studies, new knowledge emerges but with different methods. Designing these studies and collecting data is a constant challenge. Measuring the benefits of universal design in its broadest sense is even more difficult than measuring statutory access requirements.

It is at least as important to study why people choose not to use, say public transport, as it is to study the benefits for those who do. Any cost-benefit analysis of universal design and accessibility must be accompanied by what constitutes a cost and for whom.

The report presents areas for improvement and development including the ongoing exchange of experience and knowledge.

The title of the report is Universal design and socioeconomic analysis: A survey of analyses and literature. The main part of the report is in Swedish, but the English language summary begins on page 105. Included in the list of documents at the end is the Australian Building Codes Board Regulatory Impact Statement on accessible housing.

Abstract

What do measures for increased accessibility for people with disabilities cost? And what benefit do the measures provide? What analysis methods are there to evaluate the effects of increased accessibility? This report presents a survey of socio-economic analyses carried out in the Nordic countries and internationally.

An accessible society is a priority goal for the Nordic countries’ disability policy. The concept of universal design has become increasingly central to the Nordic countries’ work.

Calculations of the costs and benefits of measures for increased accessibility are requested by authorities and companies as well as organizations. The report presents studies, methods and analyses to evaluate the benefits and costs of various measures within universal design and accessibility. 

The focus is on cost-benefit analyzes and impact studies. The mapping has been carried out via a literature search, surveys to experts and two workshops. A total of 45 studies and seven literature reviews are presented in an English-language appendix. 

The Era of the New Normal

If we really want inclusive and accessible cities, we have to build it into city-wide master plans. Concepts of inclusion are integral to concepts of resilience but not often recognised as such. Victor Santiago Pineda discusses inclusion, universal design and the digital transformation of cities for the “new normal” in his book chapter.

Working together towards a common goal can enhance the overall resilience of the city.

By building inclusion and access into city-wide master plans, cities are taking steps to becoming Smart Nations.

View from high building in Brisbane overlooking building roofs and the Brisbane river and bridges. Jacaranda trees can be seen in the street. It's about people and planet and political barriers.

Pineda provides examples from New York, Barcelona, Singapore, Dubai and other global cities.

A night time view of iconic buildings in Singapore.

7 principles for the “new normal”

These 7 principles are discussed in more detail in the book chapter.

1. Reflection—using past experiences to inform future decisions

2. Resourcefulness—recognizing alternative ways to utilize resources

3. Inclusivity—prioritizing broad consultation to create a sense of shared ownership in decision-making

4. Integration—bringing together a range of distinct systems and institutions

5. Robustness—well-conceived, constructed, and managed systems

6. Redundancy—spare capacity purposefully created to accommodate disruption

7. Flexibility—willingness and ability to adopt alternative strategies in response to changing circumstances

Emerging trends – belonging by design

Clear human rights frameworks, standards for accessible and usable digital products, collaboration with civil society organisations, and risk management plans. These elements and others are discussed in the context of universal design principles. “The emerging measures presented in this book build off Universal Design to help urban practitioners build belonging by design.”

Leading cities are not waiting for a transformation to take place – city leaders are taking charge. “There is a global movement building to accelerate an inclusive urban transformation”.

The very tall tower buildings form the city skyline in Dubai.

There is an urgent need for cities to prioritize inclusion and belonging in order to create truly sustainable and equitable communities. By adopting a unified and holistic approach, we can build cities that foster a sense of belonging for all residents.

The title of the book chapter by Victor Santiago Pineda is The Era of the New Normal in Inclusion and Belonging in Cities of Tomorrow.

From the abstract

Leading smart cities are transforming their urban planning processes by building inclusion and access into their city-wide master plans. This is resulting in cities that are more accessible, inclusive, and resilient.

A key factor is the adoption of key principles of resilience in their decision-making and planning processes. These include reflection, resourcefulness, inclusivity, integration, robustness, redundancy, and flexibility.

Inclusivity is crucial in building resilience. Cities need to prioritize broad consultation and create a sense of shared ownership in decision-making complemented by the use of human-rights based regulatory frameworks.

Universal design principles can also enhance the effectiveness of radical inclusion efforts. The practice of universal design has expanded to include policy, social participation, and health and wellness.

The ultimate success of these initiatives is also dependent on the ability of cities to effectively adopt and integrate technologies in a way that supports the needs of all citizens.

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.

Older adults, colour and design

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.

A pile of brightly coloured squares sit untidily on top of each other. The colours are very bright.

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
Kitchen with white benches contrasting with the light brown floor.

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.

The colours of the rainbow arranged as a wheel

The title of the study is, Colour in the environment for older adults.

From the abstract

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.

Citizen design science as co-design

Co-design strategies vary according to the context and complexity of the project. Co-design processes are not new – academics have carried out participatory action research (PAR) for many years. Often these studies are about solving a social problem. New versions of co-design are emerging as a means of democratising design decisions. Citizen science is a version of co-design that has its roots in environmental monitoring. This method is now used in urban planning and design.

The transformation of a car park into a multifunctional public space is the subject of a citizen science paper from Turkey. The authors explain the project and how they went about engaging with citizens. The co-design process relies on communication between designers, residents, visitors and the local authority.

An additional outcome of the project was to establish a Citizen Participation Unit within the municipal authority to facilitate citizen coordination.

Graphic depiction of the Citizen Design Science framework.

A key element of successful co-design is finding ways to design with non-designers through every stage of the project. Establishing a common language is essential for understanding the needs and thoughts of all participants.

Local residents provide information and issues about the area to expert designers who then evaluate and document the information. To ensure participation of citizens who are blind or have low vision, 3D and relief formats of design elements were provided. Using roundtable discussions and digital mapping, two conceptual designs were provided to citizens for voting.

Citizen Design Science

Citizen design science is a synthesis of citizen science and design science that uses a bottom-up approach. The authors break down the process into three parts:

  • Citizen science – type of data collected from participation
  • Citizen design – citizens actively design
  • Design science – translation of citizens’ ideas into designs by expert designers

The study showed that people without prior design knowledge are able to work constructively with professional designers.

Four photos here. Top two show three dimensional modeling of concepts. Two bottom photos show people sitting at tables outdoors discussing designs.

The title of the paper is, Co-Design of a Public Space and the Implementation: Atakent (Car) Park. The paper has several illustrations of the project.

From the abstract

Citizen Design Science is a co-design strategy for urban and architectural systems that uses design tools for citizens’ observation, experience, and local knowledge. The strategy improves the planning, design, and management of cities, urban habitats, and architectural structures.

This study is about the transformation of Atakent Car Park Area into a public space using a co-design process. Using design science data, two conceptual urban design projects were prepared. This included 178 local citizens’ wishes, needs, and suggestions about the area. Participating citizens were asked to vote for their preferred project and the selected conceptual design was implemented.

The remarkable aspect of this study is the engagement of a layperson without prior design knowledge in utilizing active design tools to establish a common language with a professional designer. Despite the efficacy of this common language facilitated by the tool, it has inherent limitations.

From Vitruvian to the Variable

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 classic image of Michelangelo's Vitruvian Man standing with arms outstretched and legs apart.

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 title of the paper is, Beyond the Body: Rethinking the architectural module to promote social inclusion. The paper is in both Italian and English. The authors use a good deal of academic prose in the English version.

Vitruvian Man

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.

Ageing communities: Policy blind spots


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.

A child is kneeling down by the side of a lily pond. Her mother on one side and her grandmother on the other, also kneeling down. Grandfather is standing behind watching them.

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.

Two women sit on a bird nest swing.

For more on this topic see Most older Australians aren’t in aged care. Policy blind spots mean they live in communities that aren’t age-friendly in The Conversation.

Stay put or go? Renters lack choice

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.

A family room with a couch, cushions and a throw.

For more see Should I stay or should I go? Most older Australians want to retire where they are, but renters don’t always get a choice, in The Conversation.

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.

Accessibility Toolbar