Cities that care, not simply care homes

This post is a reaction to presentations and debate at a Royal Institute of Navigation (RIN) event on Dementia and Navigation at UCL yesterday. Most of what I’ll write is trying to understand some issues of design for dementia from alternative perspectives raised at the event.

Wandering

Wandering: a person with dementia walking around, sometimes indoors but often outdoors, is something that causes high levels of anxiety for carers (both relatives and professionals). People can leave their home without warning and get completely lost.

The image above is the wandering paths made by people at a care centre in Ireland designed by architect, Niall McLaughlin, who spoke at the RIN event. The building was designed with wandering in mind.

There is a tension here.

• The anxiety of carers for the safety of people with dementia leaving: getting lost, getting injured.
• The need of people with dementia to wander: to walk, to find sensory experiences, to try and find lost places, people, memories.

Wandering is a pejorative term. It is a medical term. It is taking walking (an act that is, for everyone else, talked of in terms of healthiness and social interaction) and pathologising it.

There is a problem here.

Wandering is a problem for those who care for people with dementia but we do not know enough about what its benefits are.

Walking around, meeting people and talking. In any other circumstance would be viewed as positive behaviour. In dementia care, it is not.

In this we know why wandering is a problem but know very little about what it means to people with dementia. We don’t know what the intent, the purpose is from the person’s perspective.

Deliberate loss of agency and loss of autonomy are professional responses that, in general, are not viewed as valid in person-centered care or independent living. Wandering may have benefits and it’s worth imagining how design might help.

Design for wandering

I’m involved, peripherally, in a large public space project in the UK to advise on Cognitive Accessibility. Mostly this means trying to point out issues around comfort and clarity for people with dementia and autistic people.

What I am wondering about now is how could we use large public spaces to safely enable wandering?

How can we balance the clear need to walk that wandering demonstrates so strongly for people with dementia with the safety and anxiety issues of carers?

Memory walks

One possibility is the deliberate design of public spaces with memory walks.

Placing art, artefacts and wayfinding to create routes within city centres. An augmentation of a shopping mall or High Street with deliberate points of reference.

Linking these moments together in circular ways creates a wandering route that loops.

This use of designed space has two purposes:

• A place for people to wander
• A place where wandering people are known to be

This is enabling wandering as a positive aspect of life: walking for health and social contact for wellbeing.

It is also deliberately using space to engage, enrapture and involve people so they can be safe and can be found.

We do not design public spaces for people with dementia and thus worry they are unsafe when out. We must try and understand how we can use space creatively to enable wandering without that sense of fear.

Cities that care not care homes

The rise in ageing population globally shows we need to think about design for dementia not in terms of care homes but in terms of whole cities. It’s not a few people for a few years. This is long term needs for large populations.