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A checklist of
recommendations for
designing dementia-friendly
outdoor environments
Neighbourhoods
for life
Introduction
This checklist gives a range of
design recommendations to help
housing associations improve the
quality of life of older people with
dementia in the outdoor
environment.
We explain how older people with
dementia experience and use
their local neighbourhoods and
make a series of
recommendations for ensuring
that the outdoor environment is
dementia-friendly. The
recommendations are listed in a
loose-leaf checklist inside the
booklet. They are referred to
within the text using the
abbreviation ‘CR’ for ‘Checklist
Recommendation’.
The recommendations are based
on the findings of a three-year
research project funded by the
Engineering and Physical
Sciences Research Council
(EPSRC). The research was
carried out by Elizabeth Burton,
Lynne Mitchell and Shibu Raman
in the Oxford Centre for
Sustainable Development, Oxford
Brookes University.
In the research, people with and
without dementia were
interviewed and accompanied on
short walks around their local
neighbourhoods. This was to find
out how they understand and use
the outside environment, how
they find their way around, and
which features help or hinder
them.
The number of older people is
steadily rising, particularly in the
85+ age group. As the likelihood
of developing dementia increases
with age, reaching a one in five
chance over the age of 80, the
number of people with dementia
is also growing.
Lifetime Homes standards give
housing the flexibility to meet the
changing needs of ageing
residents. Unless streets, places
and open spaces also meet the
needs of an ageing population,
many older residents will
effectively be housebound.
Many older people find the outdoor
environment difficult to use
This is particularly the case for
people with dementia who have
orientation and short-term
memory problems. These reduce
their ability to find their way
around, to recognise or
understand where they are, or to
remember where they are going.
Like many other people, they also
often experience frailty, sensory
impairment, poor mobility and
reduced strength and stamina.
By creating outdoor environments
that even people with dementia
can use easily and safely, housing
developments can become
neighbourhoods for life.
Where older people with
dementia choose to live
Older people with dementia
usually live at home until a crisis
causes them to move into care.
This is partly due to the limited
availability of care facilities, but
most older people with dementia
prefer to stay at home for as long
as possible.
If adequate care is available,
remaining in the familiar home
environment can contribute to
physical, cognitive and emotional
wellbeing. For those no longer
able to cope, moving into
sheltered housing or residential
care in the same neighbourhood
enables them to continue to
benefit from familiar surroundings
and social links.
How older people with
dementia use the outdoor
environment
Older people with dementia
continue to go out alone, many
daily. Most enjoy going out and
feel that it greatly enhances their
sense of independence and self-
respect. However, they are far
more physically restricted in their
independent use of the outdoor
environment than older people
without dementia. As they no
longer drive and often will not use
public transport on their own,
their choice of destination is
limited to places within close
walking distance of home.
The most popular outdoor
activities for older people with
dementia are visiting the local
shops, post office and park, and
going for short walks. Most prefer
relatively easy trips, such as
posting a letter, buying a
newspaper or taking the dog for a
walk. Some continue to enjoy
more socially demanding outings,
such as visiting friends or going to
church or the library.
Going for walks in informal open
spaces is a valued activity
People with dementia tend to feel
more comfortable in informal
places, such as streets, parks
and small open spaces with
plenty of activity. Formal places,
such as large public squares with
imposing buildings and an
expanse of empty space can feel
rather intimidating.
When developing new housing or
regenerating existing schemes,
an assessment should be made
of how close and accessible local
shops and other services and
facilities are. It is also important
to determine whether they could
cater for an increase in clientele.
Housing associations are advised
that facilities and services should
be within a 10 minute (800m)
walk or a 30 minute bus/train ride
of dwellings. This is based on
younger adults walking in
relatively flat areas. People in
their mid-seventies generally
have about half the strength and
stamina of a thirty year old. They
will, therefore, take around 10 to
20 minutes to walk 500m.
Secondary services and facilities,
including a park or other form of
open space, library and places of
worship should ideally be no
further than 800m. This will be
easier to achieve in relatively
compact areas where the
government’s target of building
30 to 50 homes per hectare are
met (CR1, CR2).
How older people with
dementia understand and find
their way around the outdoor
environment
Many older people with dementia
lose their way. This happens most
frequently at complicated decision
points, such as road crossings and
junctions. It can also happen on
streets where it is difficult to see
the route ahead; when following a
less familiar route; or when losing
concentration.
People with dementia recognise
and remember streets, places,
buildings and features that they
have seen regularly for a long
time. Any change to an area
should, therefore, be small-scale
and incremental (CR1, CR5).
People with dementia find streets
with varied urban form easier to
recognise. They also find them
easier to find their way along than
streets identical to neighbouring
ones, and streets with identical
buildings and few distinguishing
features.
Shops, services and facilities should
be within walking distance of home
It is beneficial for older people
with dementia to live no further
than 500m from essential
services and facilities, such as a
general food store, post office,
bank and health centre.
Different features, shapes and
colours, such as varying roof
lines and a variety of tiles,
chimney pots, facades, front
doors and gardens help them to
concentrate and to know where
they are and which way to go.
The styles can be traditional or
modern as long their function is
obvious and they are seen
regularly (CR5).
People with dementia can find it
difficult to ‘read’ the nature and
use of different spaces. Physical
boundaries can help to
differentiate public from private
space. Low fencing, walls or
hedges enable passers-by to see
and use the architectural
features, house numbers and
names. This also helps the sense
of safety, as building occupants
can see onto the street (CR5).
People with dementia often find
maps and written directions
difficult to follow. Many plan their
route and visualise it as they walk
along, using a number of outdoor
features to clarify where they are
and which way they need to go.
Commonly used landmarks are
historic and civic buildings, such
as town halls and churches.
Others are distinctive structures,
such as clock or water towers
and public art; and places of
activity, including playgrounds,
parks and urban squares.
Distinctive, practical features,
such as red telephone and post
boxes; and aesthetic features,
such as gardens, trees and
planters are also often used as
wayfinding cues. People with
dementia, however, only
remember landmarks and
features if their function is
obvious and they see them
regularly.
Distinctive street furniture, in styles
familiar to older people, can be useful
wayfinding cues
It is therefore important, when
redeveloping an area, to keep as
many well-established historic,
civic and distinctive landmarks
and places of activity as possible.
New developments should
include a number of such
landmarks. Street furniture, trees,
planters and public art, in designs
recognisable to older people,
should also be kept or introduced.
However, too much street clutter
can confuse rather than help
people with dementia (CR6,
CR8).
People with dementia generally
prefer simple, well-connected
street layouts with short, fairly
narrow, gently winding streets.
These help to maintain the
concentration needed to avoid
losing the way because they
appear more interesting than
long, wide or straight streets.
Being able to see the end of a
short street or having the view
ahead constantly open up when
walking along a gently winding
street also helps people to find
their way (CR3).
An irregular grid layout provides a
variety of streets that are well
connected and have simple
junctions without blind bends or
crossroads. Staggered and T-
junctions provide a focal point at
the end of the street. Forked
junctions make it easy to see
along alternative routes (CR3).
People with dementia often find
numerous or complicated signs
confusing. However, useful signs
are those that display simple,
essential information with realistic
symbols and large, clear lettering
(CR7).
Directional signs should be
placed at important decision
points, such as large road
crossings.
It is preferable for directional
signs to be on posts and single
pointers as people with dementia
find multiple pointers or arrows
ambiguous and confusing (CR7).
The post office sign is a good
example of a locational sign. It is
familiar as it is well established. It
is easy to see from a distance, as
it is usually placed perpendicular
to the wall. It is also distinctive
and bright with large lettering in a
clear colour contrast to the
background. The red and orange
colours are particularly suitable
as older people often struggle to
distinguish colours, especially
those on the blue/green
spectrum. However, those on the
red/orange spectrum are
generally less problematic (CR7).
As too many perpendicular
locational signs on one street
would be confusing they should
be restricted to essential shops,
services and facilities. Signs
positioned flush on a wall should
Too many signs can be confusing
be in a clear contrasting colour to
that of the wall (CR7).
Safety in the outdoor
environment
Older people with dementia can
face a number of physical barriers
in the outdoor environment. People
with dementia often walk with a
slow, unsteady shuffling gait. They
cannot always interpret the
intentions of other pedestrians.
Wide footways give some
protection from being jostled
(CR9).
Frailty, an unsteady gait and
visual impairment mean that level
changes are problematic. Slight
level changes can cause
stumbling and steep changes can
be onerous. Where level changes
are unavoidable, they should
have clearly marked gentle
slopes and steps (CR9).
People with dementia often
mistake sharp colour contrasts or
paving patterns for steps or holes.
Busy patterns, such as
chessboard squares or repetitive
lines, can cause dizziness.
Reflective or shiny surfaces are
seen as wet and slippery (CR9).
Changes in road colour or
material, such as for bicycle
lanes, can be mistaken for
footways unless they are in clear
contrast to the pedestrian paving.
Similarly, black speed humps
painted with white arrows can be
misread as pedestrian crossings.
It is, therefore, essential that any
traffic measure be in clear colour
and textural contrast to that of
footway paving (CR9).
Sudden, loud sounds often startle
people with dementia.
Continuous noise, such as from
heavy traffic, affects the ability to
hear. Buffers can be used to
shield pedestrians from traffic,
including trees, on-road parking
and bicycle tracks (CR9). Older
people with dementia are slow to
react to audible signals, such as
those at pedestrian crossings.
These must be at a pitch and
timing suitable for frail older
people (CR9).
Older people require between two
to five times more lighting than
younger adults. They also
struggle to cope with deep
shadow, bright light and glare.
Buildings should be oriented and
designed to avoid creating areas
of extreme dark and light (CR5).
Patterns and sharp colour contrasts
can be disorienting
Regardless of increasing age and diminishing
capabilities, older people have the right to a
safe, dignified and healthy living environment
where they are treated as equals. Using the
recommendations in this booklet will help to
shape and re-shape outdoor environments
into welcoming, easy to use neighbourhoods
for life.
Lynne Mitchell, Elizabeth Burton and Shibu Raman
2004
For further information, please contact:
Lynne Mitchell
Oxford Centre for Sustainable Development
Department of Architecture
School of the Built Environment
Oxford Brookes University
Headington Campus
Gipsy Lane
Oxford OX3 0BP
01865 484296
lmitchell@brookes.ac.uk
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CR1 Scale of development
Changes should be incremental and small-scale
Existing places and buildings should be retained or regenerated
Housing schemes should be relatively compact
CR2 Development mix
Provide a variety of adaptable dwelling types
Locate housing no further than 500m from local primary services and
facilities, including a general food store, post office, bank, GP surgery/health
centre and public transport stops
Locate housing no further than 800m from local secondary services and
facilities, including open space, a library, places of worship, and community
and leisure facilities
CR3 Layout
Use an irregular grid layout
Have a hierarchy of street types, such as main streets, side streets, lanes,
and passageways
Street blocks should be small
Streets should be connected with bends greater than 90°
Streets should be fairly short, narrow and gently winding
Use forked, staggered or t-junctions
Provide quiet alternatives to busy streets, such as pedestrianised areas
CR4 Open space
Local open spaces should be small and informal with varied activities and
features
There should be a variety of open spaces, such as ‘village greens’,
allotments, parks
Open spaces should have access to toilets, seating, shelter, lighting and
refreshments
Open spaces should be free from motorised traffic
CR5 Building form and style
The local distinctiveness of the area should be maintained
Streets, places, buildings and architectural features should be in a variety
of local styles, colours and materials that are familiar to or easily
understood by older people
The function of places and buildings should be obvious
Entrances to places and buildings should be obvious and clearly visible
Use low walls, fences or hedges, or open fencing to separate private and
public space
Spaces and buildings should be designed and oriented to avoid creating
areas of dark shadow or bright glare
Neighbourhoods for life: design checklist
Oxford Centre for Sustainable Development and the Housing Corporation 2004
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CR6 Landmarks
Existing historic and civic buildings should be retained
Distinctive structures should be retained or included
Places of activity should be retained or included
Distinctive street furniture or aesthetic features should be positioned at
decision points, such as road crossings and junctions
CR7 Signs
Signs should give simple, essential and clear information
Signs should have non-glare lighting and non-reflective coverings
Lettering and symbols should be large (5-7.5cm high), realistic and in
clear colour contrast to the background (preferably dark lettering on a
light background)
Directional signs should preferably be on posts and single pointers
Locational signs for primary services and facilities should be positioned
perpendicular to the wall
CR8 Street furniture
Street furniture should be in designs familiar to or easily understood by
older people
Public seating should be sturdy and in materials that do not conduct
heat or cold
Public seating should have arm and back rests
Public seating should be provided every 100m
Public shelters should be enclosed and have seating
Telephone boxes should be enclosed with a level threshold
CR9 Pedestrian footways and crossings
Level changes should be avoided wherever possible
Gentle slopes, with a maximum gradient of 1 to 20, and steps should
be used where level changes are unavoidable
Level changes should be clearly marked and well lit with guards,
handrails and plain, non-slip, non-glare surfaces
Trees, on-road parking and bicycle lanes can be used to separate
pedestrians from heavy traffic
Bicycle lanes should be separated from footways and clearly marked
Pedestrian crossings and public toilets should be at ground level
Pedestrian crossings should have signals with audible cues at a pitch
and timing suitable for frail older people
Street lighting should be adequate for people with visual impairments
Footways should be wide with flat, smooth, non-slip and well
maintained paving
Paving should be plain and non-reflective in clear colour contrast and textural
contrast to walls, bicycle lanes and traffic calming measures
Grates and drains should be flush with the paving with openings smaller
than walking stick size
Oxford Centre for Sustainable Development and the Housing Corporation 2004
