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Introduction
Dementia is a common disabling condition among older people, and the prevalence is growing in all ageing societies. Both of the main dementias, Alzheimer's disease and vascular dementia, cause disorientation and difficulty with comprehension, and these can make navigating and understanding everyday environments challenging. Although severe dementia may eventually necessitate moving into a residential or nursing home, in the United Kingdom an estimated 80 per cent of people with dementia live in the community (Audit Commission 2000). Many remain active outdoors until this becomes impossible. Rarely, however, are outdoor environments considered by planners or designers in terms of the opportunities and barriers they present for a person with dementia (Blackman et al. 2003).
There is evidence that the more that older people walk and take exercise, the less their risk of dementia (Abbott et al. 2004; Larson et al. 2006; Scherder et al. 2005). There are several possible explanations for this association, including the effects of walking on cognitive activity and cardiovascular health. A study by Weuve et al. (2004) found that older women who were more physically active had better cognitive function across general cognition, memory, fluency and attention. Women with cognitive impairment who walked more also experienced less cognitive decline. Despite this evidence, little is known about how the outdoor environment may disable a person with mild to moderate dementia and therefore discourage walking, and exclude them from the benefits.
There is a body of work on dementia-friendly design but this concentrates on indoor care settings such as day centres and residential homes, although adjacent gardens have received attention. Much of this evidence is reported in a useful review by Zeisel et al. (2003). Paths with features of interest along the way have been found to decrease exit seeking from homes and improve the mood of residents. Gardens have been found to reduce attempts to leave the home, reduce aggression, improve sleep and engage family members with residents. Common spaces that are homely have been observed to reduce social withdrawal, and an ambience with meaningful and understandable sounds, sights and activities has been found to reduce agitation. Privacy has been linked with reduced aggression and agitation and better sleep.
These findings are inevitably biased towards the...