Age and Dementia Friendly Outdoor Spaces

by Ash Osborne Qualified Access Consultant, Affiliate Membership ACAA; Senior Consultant, Environments, Dementia Training Australia

Ash has a nursing background and a range of professional experience in dementia care, project management, research, OSH management and design as well as over 30 years experience in the health and aged care industry. For the past 10 years she has supported a wide range of stakeholders to create dementia and aged friendly environments that meet both the needs of organisations and older people, particularly those living with dementia.

The benefits of exposure to fresh air, sunshine and the natural environment are well established. Getting outside provides health benefits such as Vitamin D, exercise, sensory stimulation and the opportunity to engage in a wide variety of meaningful activities. Getting outdoors can also give you the opportunity to spend time alone or to socialise. People of all ages benefit from getting outdoors, including older Australians.

In 2017, there were 3.8 million Australians aged 65 and over (comprising 15% of the total population)— increasing from 5% in 1927 and 9% in 1977. The number and proportion of older Australians is expected to continue to grow. By 2057, it is projected there will be 8.8 million older people in Australia (22% of the population) aged 65 and over.

Nearly 1 in 10 of these older Australians are living with dementia. That is about 459,000 people. Without a major medical breakthrough this figure is projected to increase to 1,076,000 people by 2058.

The way we provide health and social support services to these older people has undergone a major shift over the past few decades as most people want to stay independent, remain in their home and connected to family and community for much longer. Not surprisingly, the vast majority of older people do not want to move into residential care. Our aged care system is now much more focussed on helping people to remain living at home. This is no different for people living with dementia with 70% continuing to live in the community.

So we have a large (and increasing) population of older people accessing our parks and public spaces, many of whom are also living with dementia as well as the other health, physical and sensory issues that often accompany old age. How can we ensure that the outdoor spaces we design and build can help enable these members of the community to live active, joyful lives and utilise our outdoor spaces?

There is a good evidence base around strategies and design considerations that can be adopted to create accessible, enabling and inclusive spaces for our elders. This article will provide a brief overview of some key design considerations when designing truly inclusive, accessible spaces for all.

A FEW FACTS ABOUT DEMENTIA

• Dementia is not a normal part of ageing

• Dementia is not a disease but a syndrome caused by a range of diseases, with Alzheimer’s Disease accounting for around 70% of dementias in Australia

• Nearly 1 in 10 people over the age of 65 and 3 in 10 over 85 in Australia have dementia

• Dementia is the second leading cause of death in Australia and the single greatest cause of disability in Australians over 65 years

Use a participatory design approach: When planning a project invite older people, including people living with dementia and those that support them, to be part of any community consultation. They can often offer valuable information and help with identifying potential problems and finding solutions that respond to these.

Use familiar design: Use recognisable features consistent with user expectations. If the environment is familiar this makes it easier for people to find their way around and use infrastructure. This can be as simple as selecting seating that is easily identifiable as a seat!

Provide an environment that is easy to interpret and calm: Those living with dementia commonly experience sensory challenges, with changes in the way they feel, hear or see the world. These changes can sometimes make outdoor environments quite challenging as these spaces often provide a multitude of smells, sounds and sensations which can be overwhelming. Providing calm, quite spaces within busy outdoor environments can provide a person with the chance to rest and recuperate if they are feeling overwhelmed.

An important element that can contribute to making an outdoor space easy to interpret is signage. Signage is a key part of a wayfinding strategy and, as with accessibility in general, there are some basic considerations such as that language should be clear and concise, only communicate the information that is necessary and be inclusive. For example, when selecting toilet signage, ensure that it is familiar and easily recognisable by all users. Graphics and symbols should be standardised so there meaning is clear. However, signage should be part of an overall wayfinding strategy and not used in isolation. Wayfinding should include the use of landmarks, sensory cues and be supported by the overall legibility of the site.

Good visual access: Plan for good visual access into and across the site. An easy to interpret and understand layout may increase feelings of safety and security and allow for better wayfinding. Provide good visual access to key areas or points of interest. Ensure the exit and entry points are obvious and clearly marked.

Using landmarks able to be seen from a distance, such as a feature tree, clocktower or sculpture, can assist in navigation and orientation. Paths should be logically placed in relation to key locations such as entry and exit points, drop off and pick up locations, toilets and points of interest. Dead ends should be avoided.

Provide unobtrusive safety measures: People living with dementia require an environment that is safe and easy to move around if they are to maximise their abilities. However, obvious safety features and barriers may lead to frustration and distress so potential risks need to be reduced unobtrusively.

A common problem for people living with dementia is changes in depth perception. This can mean that strong changes in contrast within ground surfaces can be perceived as a change in level, a hole or a step. This can increase the risk of falls.

Avoid patterns within ground surfaces and also consider the effects of shadowing along pathways, particularly along primary paths of travel. Provide solid, continuous paths with contrasting edges to minimise trip hazards and make the paths easy to see and navigate.

Shiny or reflective surfaces which may cause glare should also be avoided, as glare may cause confusion, disorientation, make it harder for an older person to see and may contribute to falls. Consider artificial lighting, particularly along paths, avoiding up-lighting (that could shine into a persons eyes) or uneven illumination (which can create areas of high contrast along a path).

Distinct spaces: Provide a variety of spaces to enable people to enjoy outdoor spaces all year (such as seating in the shade and in the sun for summer and winter enjoyment). Create distinct spaces for different activities so that the meaning and function of these spaces is legible and more memorable. Consider spaces for communal activity such as:

• Seating

• Open green space

• Shared, accessible gardens

• Children’s play equipment

• Night lighting

These can support the older person to remain connected with their community, retain social contacts and maintain their sense of identity in a secure and safe environment.

It is also good practice to provide opportunities for pleasant sensory experiences considering all of the senses. This can not only provide a rich, enjoyable experience, it can also aid reminiscence and provide cues to the season and location. Consider planting to provide an opportunity for meaningful engagement such as:

• bird and insect attracting plants and landscaping elements such as bird baths and water features

• providing some seating that allows people to sit facing each other to support conversation, seating that supports a small group to sit together and seating that allows for a person in a wheelchair to sit with those using fixed seating

Older people may not be able to participate in more vigorous physical activities available in outdoor spaces, so providing options for more sedentary and passive activities can provide enjoyable experiences for a wider range of users.

Provide safe and accessible outdoor spaces: Older people may have limited transport options (they may no longer drive, they may use public transport or they may be unable or reluctant to travel long distances). Walking access to appropriate outdoor spaces may help maintain independence and safety and may also provide easy access for family, friends and carers for social events.

Consideration should be given to accessibility for older people with mobility issues including the use of walking aids and wheelchairs. The needs of a carer or support person (who may also be elderly and perhaps unable to push a wheelchair long distances) should also be accommodated. Provide seating at key locations such as key drop off/pick up spots and consider shelter, lighting and safety features at these points.

Consider comfortable seating in a variety of configurations to accommodate different needs and abilities. Arm and back rests provide a seat that is easier to get in and out of by most older people and back rests can also provide ‘leaning points’ to enable a person to rest during a walk. Seating intervals of 60m (or more frequent seating if there is a steep grade) should be provided as older pedestrians may tire more easily.

CONCLUSION:

This article has only scraped the surface of some of the access considerations that can make outdoor spaces more accessible and equitable for older people and those living with dementia. With an increasing elderly population and greater focus on the development of aged and dementia friendly communities, the needs of these members of our community should be considered during the planning of any outdoor space.

Like all human beings, everyone living with dementia will be an individual dependant on their history, experience, personality and level of impairment. Dementia is a progressive disease and a person’s capacity will change over time. There is no one size fits all dementia.