How urban design can help people with dementia navigate neighbourhoods and public spaces

Roger Marple stood in front of the door to his condo unit, yet he didn't even know it.

"I'm walking up and down the hallway, I don't even know where the hell I am," said the 61-year-old, who was diagnosed with early-onset Alzheimer's disease a few years ago.

"It took me a while to figure out I was at home."

Marple says such disorientation is "something that a lot of people with dementia face" and argues that better urban design — such as signage, landmarks and clear-cut paths — can allow people to be "safely open and out and about in the community."

Marple, who lives alone with his cat Bernie in Medicine Hat, Alta., is one of over half a million Canadians living with dementia. According to the Alzheimer Society of Canada, that number is expected to reach nearly a million by 2031.

As waitlists for care facilities grow longer and more people with dementia are choosing to live within their own communities, urban planning and design will play an increasingly important role in helping them live safe, comfortable and independent lives.

Exercise and social interaction are "incredibly important" for people living with dementia, says Samantha Biglieri, an urban planner working towards her PhD at the University of Waterloo.

Shops, landmarks and pedestrian medians

Inspired by similar research in European cities, Biglieri wanted to figure out how to create dementia-inclusive public spaces in a Canadian suburban context.

Between April 2018 and February 2019, she worked with 15 people living with early-onset dementia in Ontario's Waterloo Region, walking with them in their neighbourhoods, tracking them on GPS devices and having them fill out travel diaries. All of the participants self-identified as living with milder stages of dementia, which allowed them to go out for walks on their own.

During their walkabouts, Biglieri says she realized the importance of shops, parks and community centres within residential neighbourhoods for people living with dementia.  

"For participants who could walk to a store — that made all the difference in their life…. Otherwise, you end up just walking around the block, which is what some of my participants ended up doing."

She recommends creating more commercial nodes within residential neighbourhoods. For example, building corner stores and ensuring there is a grocery store within walking distance.

"The default still in new communities and areas around the [Greater Toronto and Hamilton Area] is still this single-detached homes with commercial on the edges," she said.

Biglieri also noted the importance of landmarks — not just large structures, like statues or monuments, but smaller, unique features, like a stone garden in front of a house. Participants relied on these markers to help them with wayfinding, she explained.

"They also would say things like, 'I can see the Wal-Mart or the McDonald's sign from far away, and I know I'm going in the right direction.'"

Biglieri offered other design decisions that could make all the difference, such as lining more streets with trees so that people are shaded from the sun, and building pedestrian islands in the middle of roads so people can cross safely.

"One of the symptoms of dementia can be impaired depth perception, and so not being able to judge how far away a car is can be a real issue."

Canada's first 'dementia village'

This past summer, a senior care facility that uses similar design principles to create a dementia-inclusive community opened in Langley, B.C.

Called The Village, it's billed as "the first memory care community of its kind in Canada," modelled after communities in Holland and the U.S.

The facility consists of six cottages, each with 12 or 13 private bedrooms tailored to those living with dementia. 

Karen Tyrell, a dementia specialist who helped design some of the wayfinding cues at the facility, says the team behind the project wanted to "make it look like a home, not like a hospital."

Some of the cottages have porches and white picket fences, so that they look as familiar as possible to houses in the communities the residents are used to. Noise and visual clutter are kept to a minimum, since they can sometimes be overwhelming for people with dementia. There are also distinctive paths, lots of signage and landmarks in order to aid with wayfinding.  

"Evidence has shown that well-planned, enabling environments can have a substantial positive impact on the quality of life of someone living with dementia," Tyrell said.

Biglieri says that while models like The Village may work for some, she would also like to see solutions where people with dementia are a part of the larger community.

"We have to bring people into the community, we can't just always rely on segregation," she said.

We need to see dementia from all the faces, not just end of days.- Roger Marple, advocate and person living with dementia

Biglieri, who will be defending her dissertation in December, says it was important for her to consult people with dementia directly. "We have to ask groups that have historically been marginalized: how did they experience the city?" she said. 

Marple, who is now an advocate and public speaker, says that in addition to design, the key to making communities more dementia-friendly is to reduce stigma of the condition through education.

He wants Canadians to know that people with dementia are out in the world living full and productive lives — not just sitting in care facilities, unable to communicate and staring out of windows.

"There are a thousand faces to dementia … We need to see dementia from all the faces, not just end of days."

Written by Althea Manasan. Produced by Nora Young.