Journal of Urban Design and Mental Health; 2021:7;2
ANALYSIS
Dementia-friendly neighborhoods: Methodological challenges and research opportunities
Jessica M. Finlay
Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
Gabriella Y. Meltzer
Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City, New York, United States
Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
Gabriella Y. Meltzer
Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City, New York, United States
Citation: Finlay JM, Meltzer GY (2021). Dementia-friendly neighbourhoods: Methodological challenges and research opportunities. Journal of Urban Design and Mental Health 7;2
Abstract
Most persons living with dementia reside at home and in community contexts instead of institutional environments, and share widespread desires to ‘age in place’. Living in a safe and supportive environment is critical to physical, mental, social, and cognitive health and well-being. Dementia-friendly environments have supportive features and a cohesive system that enable persons living with dementia to remain meaningfully engaged in life. Neighborhood built and social environments are amenable to interventions to maintain and enhance the health and wellbeing of persons living with dementia. Dementia-friendly neighborhoods are a burgeoning area of transdisciplinary research. While this area of study is dynamic and rapidly evolving, there remain methodological challenges and gaps in the field that limit depth of knowledge and pose important opportunities for future research.
Introduction
Dementia-friendly neighborhoods are a burgeoning area of transdisciplinary research. Nearly twenty years ago, Mitchell and colleagues (2003) noted that environmental dementia literature focused almost exclusively on institutions’ internal design and neglected the outside world. Research on the active participation of Persons Living With Dementia (PLWD) in their neighborhoods, wayfinding abilities, and environmental needs was nonexistent. Since then, an explosion of interest and diverse methodological approaches has sought to understand the complex reciprocal relationship between neighborhood built/social environments and PLWD (Gan et al., 2021).
As the population ages, most PLWD live at home and in community contexts instead of institutional environments, and share widespread desires to ‘age in place’ (Sturge et al., 2021). Living in a safe and supportive environment is critical to physical, mental, social, and cognitive health and well-being (Finlay et al., 2018; 2020). Dementia-friendly environments have supportive features and a cohesive system that enable PLWD to remain meaningfully engaged in life (McFadden, 2021; Lin & Lewis, 2015; Davis et al., 2009). Recent research demonstrates that neighborhood built and social environments are amenable to interventions to maintain and enhance PLWDs’ health and wellbeing (Gan et al., 2021). While this area of study is dynamic and rapidly evolving, there remain methodological challenges and gaps in the field that limit depth of knowledge and pose important opportunities for future research. This commentary briefly reviews the dementia-friendly literature through four overarching themes: 1) neighborhood complexity, 2) mixed methodological approaches, 3) research participation, and 4) future research directions.
As the population ages, most PLWD live at home and in community contexts instead of institutional environments, and share widespread desires to ‘age in place’ (Sturge et al., 2021). Living in a safe and supportive environment is critical to physical, mental, social, and cognitive health and well-being (Finlay et al., 2018; 2020). Dementia-friendly environments have supportive features and a cohesive system that enable PLWD to remain meaningfully engaged in life (McFadden, 2021; Lin & Lewis, 2015; Davis et al., 2009). Recent research demonstrates that neighborhood built and social environments are amenable to interventions to maintain and enhance PLWDs’ health and wellbeing (Gan et al., 2021). While this area of study is dynamic and rapidly evolving, there remain methodological challenges and gaps in the field that limit depth of knowledge and pose important opportunities for future research. This commentary briefly reviews the dementia-friendly literature through four overarching themes: 1) neighborhood complexity, 2) mixed methodological approaches, 3) research participation, and 4) future research directions.
Neighbourhood complexity
The Built and Social Environment
What constitutes a neighborhood? This seemingly straightforward concept is difficult to define and operationalize in dementia-friendly neighborhood research—and urban and health research more broadly (Galster, 2019). It represents a complex social and geographic concept in which unambiguous, meaningful, and consensual neighborhood boundaries are difficult—perhaps impossible—to define (Hipp et al., 2012). Given the Uncertain Geographic Context Problem (Kwan, 2012), different spatial delineations can yield inconsistent results and inferential errors, a challenge that persists in dementia-friendly neighborhood research (Gan et al., 2021; Guo et al., 2019). Neighborhoods blend built and social environments, and can consist of multiple nested scales ranging from an individual-level home to a broader community and municipality, in addition to overlapping built, sociocultural, service, natural, and policy environments. Neighborhoods may even be online or non-contiguous areas, such as snowbirds who identify with more than one neighborhood or a PLWD engaged in online communities. There are thus rich opportunities to tackle neighborhood complexity and deepen understanding of interacting multi-scalar environmental features and individual characteristics.
Spatial temporality
Temporality presents additional complexity in dementia-friendly neighborhood research. Both neighborhoods and people evolve over multiple time scales, ranging from daily, to seasonal, to multi-decade. A neighborhood park, for example, may pose distinct mobility challenges in a snowy winter climate or social opportunities on a warm spring day (Finlay, 2017). Public transportation can promote independence, but if traveled when crowded, can be intimidating and stressful. Most qualitative studies describe morning activities, whereas in the late afternoon or evening, PLWD are more likely to avoid going out or rely more heavily on others (Sturge et al., 2021). Landscapes themselves experience changes and disruptions, including urban development, changing socio-demographics (e.g., gentrification, age turnover), technological advances (e.g., automated store checkouts), and natural disasters. This can cause disorientation, confusion, and alter social interactions (Biglieri, 2017; Sturge et al., 2021). Time-varying and longitudinal studies are needed to capture broader neighborhood temporal scales.
What constitutes a neighborhood? This seemingly straightforward concept is difficult to define and operationalize in dementia-friendly neighborhood research—and urban and health research more broadly (Galster, 2019). It represents a complex social and geographic concept in which unambiguous, meaningful, and consensual neighborhood boundaries are difficult—perhaps impossible—to define (Hipp et al., 2012). Given the Uncertain Geographic Context Problem (Kwan, 2012), different spatial delineations can yield inconsistent results and inferential errors, a challenge that persists in dementia-friendly neighborhood research (Gan et al., 2021; Guo et al., 2019). Neighborhoods blend built and social environments, and can consist of multiple nested scales ranging from an individual-level home to a broader community and municipality, in addition to overlapping built, sociocultural, service, natural, and policy environments. Neighborhoods may even be online or non-contiguous areas, such as snowbirds who identify with more than one neighborhood or a PLWD engaged in online communities. There are thus rich opportunities to tackle neighborhood complexity and deepen understanding of interacting multi-scalar environmental features and individual characteristics.
Spatial temporality
Temporality presents additional complexity in dementia-friendly neighborhood research. Both neighborhoods and people evolve over multiple time scales, ranging from daily, to seasonal, to multi-decade. A neighborhood park, for example, may pose distinct mobility challenges in a snowy winter climate or social opportunities on a warm spring day (Finlay, 2017). Public transportation can promote independence, but if traveled when crowded, can be intimidating and stressful. Most qualitative studies describe morning activities, whereas in the late afternoon or evening, PLWD are more likely to avoid going out or rely more heavily on others (Sturge et al., 2021). Landscapes themselves experience changes and disruptions, including urban development, changing socio-demographics (e.g., gentrification, age turnover), technological advances (e.g., automated store checkouts), and natural disasters. This can cause disorientation, confusion, and alter social interactions (Biglieri, 2017; Sturge et al., 2021). Time-varying and longitudinal studies are needed to capture broader neighborhood temporal scales.
Mixing methods
Given neighborhood complexity and diversity, methods applied in dementia-friendly neighborhood research are relatedly broad and incorporate a range of qualitative and quantitative approaches to examine environmental and psychosocial features. Quantitative studies tend to investigate statistical associations and audit discrete environmental features. Qualitative studies generally involve more interpretive approaches through seated and walking interviews, photovoice, and focus groups. There is additional need for mixed-methods approaches in dementia-friendly neighborhood research (Gan et al., 2021). Mixing data together can generate novel inquiry and more comprehensive understanding of multifaceted health research questions (Creswell et al., 2011; Tariq & Woodman, 2013). This requires greater collaboration between disciplines and research teams, and enhanced mixed-methods training for scholars.
Multi-sensory assessment
Neighborhood environments are multi-sensory, involving sight, sound, smell, taste, and touch. Technological advances enable new opportunities to investigate wayfinding, safety, memory, and information processing among PLWD navigating their environments. Eye-tracking studies (largely in laboratory settings to-date), for example, attend to visual scanning and processing such as obstacle contrast and navigational cues (Alcock et al., 2020; Grzeschik et al., 2019; Hunt et al., 2018). Trivic and Low (2021) employed a multi-modal combination of mobile eye-tracking and post-walk interviews to capture and analyze older adults’ visual attention and multi-sensory experiences while walking through housing neighborhoods. Qualitative research methods such as walking interviews and photovoice give credence to visual cues in real-world settings such as landmarks, signage, streets, and traffic (Mitchell et al., 2003; Mitchell & Burton, 2006; Sheehan et al., 2006). A small, but growing, number of studies incorporate sounds and other sensations, such as children playing or yelling, birds singing, the whoosh of traffic, pressing pedestrian crossing cues, and feeling heat and humidity (Sturge et al., 2021; Finlay, 2017 & Bowman). Walking interviews generate rich data and knowledge about participants’ multi-sensory connections to their environments (Evans & Jones, 2011). While it raises potential logistical and safety challenges (Adekoya & Guse, 2020) to expand interviews and go-alongs to broader mobilities, dementia-friendly neighborhood research could expand mobile interviews to the bus, bike, car, ferry, and train to gain further insight on places frequented by PLWD that are beyond walking-distance. This would expand exploration of neighborhoods as multidimensional social and physical spaces, and better capture the active role of PLWD as place-makers (Keady et al., 2012).
Participatory methods
To ensure that dementia-friendly neighborhoods empower and meet the needs of PLWD, best practice is to actively involve PLWD in the research process (Wiersma et al., 2016). They are best-positioned to identify areas of need, prioritize neighborhood issues, and guide appropriate implementation. Community-based participatory research can involve PLWD and their care partners (Manthorpe & Iliffe, 2018), as well as broader stakeholders in the neighborhood constellation of care, services, stimulation, and support. While potentially more logistically challenging and resource-intensive, community-led initiatives such as workshops, community forums, and co-design strategies can identify varied neighborhood features to create more effective programs, policies, and services that build towards a more cohesive dementia-friendly community (Courtney-Pratt et al., 2018; Sturge et al., 2021). The lack of (English language) community-based trials and participatory research may be due to insufficient funding mechanisms for infrastructure and behavioral-psychosocial interventions (Gan et al., 2021). It is critical to find innovative ways to involve and compensate PLWD and broader stakeholders as researchers to minimize harms, foster greater inclusion and co-production of knowledge, and generate more supportive neighborhoods.
Research participation
Stages of Cognitive Decline
Given the growing population of older adults worldwide, it is important that dementia-friendly neighborhood research includes a diverse array of PLWD in order to best address their needs. Dementia occurs on a medical continuum both between and within individuals. Diagnoses are inconsistent and based on non-universal criteria, as exemplified by diverse cognitive statuses among study participants ranging from age-associated cognitive decline, to mild cognitive impairment and more advanced dementia and Alzheimer’s disease (Lo, 2017). Cognitive decline is also not linear, and can be influenced by environmental stimuli. This is especially evident with sundowning given time of day (Canevelli et al., 2016). Scant English language dementia-friendly neighborhood research to-date involves older adults with advanced dementia, perhaps given ethical and methodological challenges such as obtaining consent from PLWD or authorized third-party proxy; heightened risk for participant agitation, discomfort, and fatigue; and safety concerns such as wandering (Adekoya & Guse, 2020). Further dementia-friendly neighborhood research is needed with participants across the full continuum of cognitive decline to accommodate and engage those at various stages of impairment.
PLWDs' Social and Care Networks
Dementia-friendly neighborhood research should not only focus on PLWD, but also the constellation of people who comprise their social and care networks. Care partners are the most frequently-involved additional research participants to provide supplemental data or as the purposeful focus of research (Gan et al., 2021; Silverman, 2019). Additional stakeholders include immediate family members, hired caregivers, informal networks of extended family and friends, and other individuals with whom community-dwelling PLWD individuals interact with regularly (e.g., store clerks, doormen, clergy). These individuals not only help PWLD with activities of daily living, but also advocate for them and help them navigate their social and physical environments. While it is challenging and resource-intensive to expand the range of participants involved in studies, it is imperative that dementia-friendly neighborhood research do so. This will assist efforts to develop environments that are conducive to effective caregiving and accommodate the needs of diverse caregivers themselves in their oftentimes emotionally, physically, and mentally demanding roles (Kürten et al., 2021; Anderson et al., 2020; Kallitsis et al., 2019; Rote, Angel, Markides, 2017).
Sociodemographic Diversity
Participants in dementia-friendly neighborhood research should also reflect the diversity of the aging population, as most participants currently included are White and relatively affluent. Racial/ethnic minorities, those who identify as LGBTQ+, those of low socioeconomic status, immigrants/migrants/refugees, and Indigenous community members often reside in enclaves (or reservations, in the case of Native Americans) and have unique needs and lived experiences that need to be evaluated and met (Garrett et al., 2015; Adames, et al 2020; Hulko, 2016). Although marginalized populations are more difficult to reach, it is important to account for disparities in their greater risk of developing dementia, delayed diagnosis, and insufficient care and support at the interpersonal and neighborhood levels (Tsoy et al., 2021). For example, a qualitative study of challenges for African Americans aging in place in the Atlanta (USA) metropolitan area found that participants faced unique obstacles, including stigma and shame, as well as a knowledge deficit on the part of providers and caregivers. Many were also low-income and raised issues including lack of affordable housing, gentrification, personal financial constraints, low access to resources, and poor walkability and transportation (Epps et al., 2018).
Geographic Contexts
The vast majority of English language dementia-friendly neighborhood research takes place in relatively homogenous contexts, particularly Western countries and urban/suburban settings. Given advances in public health and medicine leading to prolonged longevity in non-Western countries, developing nations need to accommodate the needs of PLWD. They lack relevant evidence from dementia-friendly neighborhood research, such as in rapidly urbanizing contexts. PLWD in informal settlements can face novel and under-studied challenges. Rural contexts in North America also tend to be overlooked in this area of research, as they are often not conceptualized as traditional neighborhoods. They can present challenges such as social isolation, lack of walkability, and limited public transportation that inhibits social and physical connectivity to places outside the home (Innes et al., 2020). However, it may be easier in a rural environment to connect socially to nearby family and friend support networks, as well as physically to nature (Keatin, 2008; Wiersma and Denton, 2016).
Third Places
A growing body of recent dementia-friendly neighborhood research has and should continue to focus on ‘third places’, which foster community, communication, and care among people outside of school/work and home (Jeffres et al., 2009). Igarashi and colleagues (2020) conducted a community-based participatory intervention study in Nerima City, Japan to encourage collaboration between convenience store owners, managers, and healthcare and social workers to improve functional support for community-dwelling PLWD. One qualitative study using photo documentation and focus groups evaluated the accessibility of grocery stores for PLWD in Sweden (Brorsson et al., 2018), and a qualitative study in Japan assessed how dementia cafés could serve as community resources for PLWD (Takechi et al., 2018). Other dementia-friendly neighborhood studies of third places frequented by PLWD could include pharmacies, places of worship, banks, nail and hair salons, diners, and recreation centers. A notable challenge is that neighborhood-based interventions are often complex and resource-intensive, requiring a multi-year commitment and ongoing consensus among researchers and local stakeholders.
Given the growing population of older adults worldwide, it is important that dementia-friendly neighborhood research includes a diverse array of PLWD in order to best address their needs. Dementia occurs on a medical continuum both between and within individuals. Diagnoses are inconsistent and based on non-universal criteria, as exemplified by diverse cognitive statuses among study participants ranging from age-associated cognitive decline, to mild cognitive impairment and more advanced dementia and Alzheimer’s disease (Lo, 2017). Cognitive decline is also not linear, and can be influenced by environmental stimuli. This is especially evident with sundowning given time of day (Canevelli et al., 2016). Scant English language dementia-friendly neighborhood research to-date involves older adults with advanced dementia, perhaps given ethical and methodological challenges such as obtaining consent from PLWD or authorized third-party proxy; heightened risk for participant agitation, discomfort, and fatigue; and safety concerns such as wandering (Adekoya & Guse, 2020). Further dementia-friendly neighborhood research is needed with participants across the full continuum of cognitive decline to accommodate and engage those at various stages of impairment.
PLWDs' Social and Care Networks
Dementia-friendly neighborhood research should not only focus on PLWD, but also the constellation of people who comprise their social and care networks. Care partners are the most frequently-involved additional research participants to provide supplemental data or as the purposeful focus of research (Gan et al., 2021; Silverman, 2019). Additional stakeholders include immediate family members, hired caregivers, informal networks of extended family and friends, and other individuals with whom community-dwelling PLWD individuals interact with regularly (e.g., store clerks, doormen, clergy). These individuals not only help PWLD with activities of daily living, but also advocate for them and help them navigate their social and physical environments. While it is challenging and resource-intensive to expand the range of participants involved in studies, it is imperative that dementia-friendly neighborhood research do so. This will assist efforts to develop environments that are conducive to effective caregiving and accommodate the needs of diverse caregivers themselves in their oftentimes emotionally, physically, and mentally demanding roles (Kürten et al., 2021; Anderson et al., 2020; Kallitsis et al., 2019; Rote, Angel, Markides, 2017).
Sociodemographic Diversity
Participants in dementia-friendly neighborhood research should also reflect the diversity of the aging population, as most participants currently included are White and relatively affluent. Racial/ethnic minorities, those who identify as LGBTQ+, those of low socioeconomic status, immigrants/migrants/refugees, and Indigenous community members often reside in enclaves (or reservations, in the case of Native Americans) and have unique needs and lived experiences that need to be evaluated and met (Garrett et al., 2015; Adames, et al 2020; Hulko, 2016). Although marginalized populations are more difficult to reach, it is important to account for disparities in their greater risk of developing dementia, delayed diagnosis, and insufficient care and support at the interpersonal and neighborhood levels (Tsoy et al., 2021). For example, a qualitative study of challenges for African Americans aging in place in the Atlanta (USA) metropolitan area found that participants faced unique obstacles, including stigma and shame, as well as a knowledge deficit on the part of providers and caregivers. Many were also low-income and raised issues including lack of affordable housing, gentrification, personal financial constraints, low access to resources, and poor walkability and transportation (Epps et al., 2018).
Geographic Contexts
The vast majority of English language dementia-friendly neighborhood research takes place in relatively homogenous contexts, particularly Western countries and urban/suburban settings. Given advances in public health and medicine leading to prolonged longevity in non-Western countries, developing nations need to accommodate the needs of PLWD. They lack relevant evidence from dementia-friendly neighborhood research, such as in rapidly urbanizing contexts. PLWD in informal settlements can face novel and under-studied challenges. Rural contexts in North America also tend to be overlooked in this area of research, as they are often not conceptualized as traditional neighborhoods. They can present challenges such as social isolation, lack of walkability, and limited public transportation that inhibits social and physical connectivity to places outside the home (Innes et al., 2020). However, it may be easier in a rural environment to connect socially to nearby family and friend support networks, as well as physically to nature (Keatin, 2008; Wiersma and Denton, 2016).
Third Places
A growing body of recent dementia-friendly neighborhood research has and should continue to focus on ‘third places’, which foster community, communication, and care among people outside of school/work and home (Jeffres et al., 2009). Igarashi and colleagues (2020) conducted a community-based participatory intervention study in Nerima City, Japan to encourage collaboration between convenience store owners, managers, and healthcare and social workers to improve functional support for community-dwelling PLWD. One qualitative study using photo documentation and focus groups evaluated the accessibility of grocery stores for PLWD in Sweden (Brorsson et al., 2018), and a qualitative study in Japan assessed how dementia cafés could serve as community resources for PLWD (Takechi et al., 2018). Other dementia-friendly neighborhood studies of third places frequented by PLWD could include pharmacies, places of worship, banks, nail and hair salons, diners, and recreation centers. A notable challenge is that neighborhood-based interventions are often complex and resource-intensive, requiring a multi-year commitment and ongoing consensus among researchers and local stakeholders.
Future Directions
The impact of dementia-friendly neighborhoods on quality of life, functioning, and health for PLWD since the COVID-19 pandemic onset remains unknown. Many neighborhood resources that are critical sources of socialization, stimulation, and services remain closed or tightly restricted, or PLWD may fear returning to them as restrictions are lifted. The avoidance of public spaces, isolation, limiting of travel, and permanent business closures may have long-term consequences for the advancement of dementia-friendly neighborhoods. There may be an expansion of online neighborhood networks and technology-based service usage among PLWD and their care networks. Researchers may also need to maintain greater physical distancing and face additional ethical and practical challenges for in situ research methods in a post-COVID-19 world (Shareck et al., 2021). The pandemic poses many unknowns and potential recalibrations to dementia-friendly neighborhood research, with immense opportunities for innovative and creative methodologies to advance the field.
About the authors
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Jessica Finlay is a postdoctoral research fellow in the Social Environment and Health Program at the University of Michigan’s Institute for Social Research. She is a health geographer and environmental gerontologist with an MA and PhD in Geography and Gerontology from the University of Minnesota. Dr. Finlay uses qualitative, geospatial, and mixed-methods to investigate the role of built, social, natural, and microbial environments for health and well-being in later life. Her research focuses on how neighborhood environments may increase risk for dementia or help buffer against cognitive decline. Dr. Finlay also investigates psychosocial and behavioral impacts of the COVID-19 pandemic on the physical, mental, social, and cognitive health of aging adults.
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Gabriella Meltzer is a doctoral candidate in Social and Behavioral Sciences at New York University School of Global Public Health. Her research interests broadly encompass how environmental exposures—ranging from natural hazards, technological disasters, biohazards, and industrial pollution—create and exacerbate health disparities at critical and sensitive periods of the life course, including infancy, childhood and adolescence, pregnancy, and old age. She uses a variety of methods to explore these issues, including quantitative data analysis, in-depth interviewing and qualitative data analysis, community-based participatory research, and geospatial analysis. Prior to NYU, Meltzer received her BA in Health and Societies from the University of Pennsylvania and was a Global Health Research Associate at the Council on Foreign Relations.
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References
Adames, H., & Tazeau, Y. (Eds.). (2020). Caring for Latinxs with Dementia in a Globalized World. New York City, New York: Springer Nature.
Adekoya, A. A., & Guse, L. (2020). Wandering Behavior From the Perspectives of Older Adults With Mild to Moderate Dementia in Long-Term Care. Res Gerontol Nurs, 12(5), 239-247. doi:10.3928/19404921-20190522-01
Alcock, L., Galna, B., Hausdorff, J. M., Lord, S., & Rochester, L. (2020). Enhanced Obstacle Contrast to Promote Visual Scanning in Fallers with Parkinson's Disease: Role of Executive Function. Neuroscience, 436, 82-92. doi:10.1016/j.neuroscience.2020.03.032
Anderson, J., Flatt, J., Tree, J. J., Gross, A., & Rose, K. (2020). Leveraging Digital Methods to Engage Sexual and Gender Minority Caregivers of People With Dementia. Innovation in Aging, 4(S1). doi:10.1093/geroni/igaa057.2775
Biglieri, S. (2017). Implementing Dementia-Friendly Land Use Planning: An Evaluation of Current Literature and Financial Implications for Greenfield Development in Suburban Canada. Planning Practice & Research, 1-27. doi:10.1080/02697459.2017.1379336
Brorsson, A., Ohman, A., Lundberg, S., Cutchin, M. P., & Nygard, L. (2020). How accessible are grocery shops for people with dementia? A qualitative study using photo documentation and focus group interviews. Dementia (London), 19(6), 1872-1888. doi:10.1177/1471301218808591
Canevelli, M., Valletta, M., Trebbastoni, A., Sarli, G., D'Antonio, F., Tariciotti, L., . . . Bruno, G. (2016). Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches. Front Med (Lausanne), 3, 73. doi:10.3389/fmed.2016.00073
Courtney-Pratt, H., Mathison, K., & Doherty, K. (2018). Distilling authentic community-led strategies to support people with dementia to live well. Community Development, 49(4), 432-449. doi:10.1080/15575330.2018.1481443
Creswell, J. W., Klassen, A. C., Plano Clark, V. L., & Smith, K. C. (2011). Best Practices for Mixed Methods Research in the Health Sciences. Washington, DC: Office of Behavioral Social Sciences Research.
Davis, S., Byers, S., Nay, R., & Koch, S. (2009). Guiding design of dementia friendly environments in residential care settings: Considering the living experiences. Dementia, 8(2), 185-203. doi:10.1177/1471301209103250
Epps, F., Weeks, G., Graham, E., & Luster, D. (2018). Challenges to aging in place for African American older adults living with dementia and their families. Geriatr Nurs, 39(6), 646-652. doi:10.1016/j.gerinurse.2018.04.018
Evans, J., & Jones, P. (2011). The Walking Interview: Methodology, Mobility And Place. Applied Geography, 31(2), 849-858. doi:10.1016/j.apgeog.2010.09.005
Finlay, J., Esposito, M., Tang, S., Gomez-Lopez, I., Sylvers, D., Judd, S., & Clarke, P. (2020). Fast-food for thought: Retail food environments as resources for cognitive health and wellbeing among aging Americans? Health Place, 64, 102379. doi:10.1016/j.healthplace.2020.102379
Finlay, J. M. (2017). 'Walk like a penguin': Older Minnesotans' experiences of (non)therapeutic white space. Soc Sci Med, 198, 77-84. doi:10.1016/j.socscimed.2017.12.024
Finlay, J. M., & Bowman, J. A. (2017). Geographies on the Move: A Practical and Theoretical Approach to the Mobile Interview. The Professional Geographer, 69(2), 263-274. doi:10.1080/00330124.2016.1229623
Finlay, J. M., Gaugler, J. E., & Kane, R. L. (2018). Ageing in the margins: expectations of and struggles for ‘a good place to grow old’ among low-income older Minnesotans. Ageing & Society, 40(4), 759-783. doi:https://doi.org/10.1017/S0144686X1800123X
Galster, G. C. (2019). Making Our Neighborhoods, Making Our Selves. Chicago, IL: University of Chicago Press.
Gan, D. R. Y., Chaudhury, H., Mann, J., & Wister, A. V. (2021). Dementia-friendly neighbourhood and the built environment: A scoping review. Gerontologist. doi:10.1093/geront/gnab019
Garrett, M. D., Baldridge, D., Benson, W., Crowder, J., & Aldrich, N. (2015). Mental health disorders among an invisible minority: depression and dementia among american Indian and alaska native elders. Gerontologist, 55(2), 227-236. doi:10.1093/geront/gnu181
Grzeschik, R., Conroy-Dalton, R., Innes, A., Shanker, S., & Wiener, J. M. (2019). The contribution of visual attention and declining verbal memory abilities to age-related route learning deficits. Cognition, 187, 50-61. doi:10.1016/j.cognition.2019.02.012
Guo, Y., Chan, C. H., Chang, Q., Liu, T., & Yip, P. S. F. (2019). Neighborhood environment and cognitive function in older adults: A multilevel analysis in Hong Kong. Health Place, 58, 102146. doi:10.1016/j.healthplace.2019.102146
Hipp, J. R., Faris, R. W., & Boessen, A. (2012). Measuring ‘neighborhood’: Constructing network neighborhoods. Social Networks, 34(1), 128-140. doi:10.1016/j.socnet.2011.05.002
Hulko, W. (2016). LGBT* individuals and dementia: an intersectional approach. In S. Westwood & E. Price (Eds.), Lesbian, Gay, Bisexual and Trans* Individuals Living with Dementia (pp. 55-70). Milton Park, Oxfordshire: Routledge.
Hunt, D., Stuart, S., Nell, J., Hausdorff, J. M., Galna, B., Rochester, L., & Alcock, L. (2018). Do people with Parkinson's disease look at task relevant stimuli when walking? An exploration of eye movements. Behav Brain Res, 348, 82-89. doi:10.1016/j.bbr.2018.03.003
Igarashi, A., Matsumoto, H., Takaoka, M., Kugai, H., Suzuki, M., Murata, S., . . . Yamamoto‐Mitani, N. (2020). Community‐based participatory approach to promote convenience stores’ support for older adults with dementia in Japan. Alzheimer's & Dementia, 16(S8). doi:10.1002/alz.039157
Innes, A., Morgan, D., & Farmer, J. (Eds.). (2020). Remote and Rural Dementia Care: Policy, Research and Practice. Great Britain: Policy Press.
Jeffres, L. W., Bracken, C. C., Jian, G., & Casey, M. F. (2009). The Impact of Third Places on Community Quality of Life. Applied Research in Quality of Life, 4(4), 333-345. doi:10.1007/s11482-009-9084-8
Kallitsis, P., Soilemezi, D., & Elliott, A. M. (2019). Disabling Spaces and Spatial Strategies: Feminist Approaches to the Home Environment of Family Caregivers of People with Dementia. Home Cultures, 15(3), 265-287. doi:10.1080/17406315.2018.1690293
Keady, J., Campbell, S., Barnes, H., Ward, R., Li, X., Swarbrick, C., . . . Elvish, R. (2012). Neighbourhoods and dementia in the health and social care context: a realist review of the literature and implications for UK policy development. Reviews in Clinical Gerontology, 22(2), 150-163. doi:10.1017/s0959259811000268
Keating, N. (Ed.) (2008). Rural ageing: A good place to grow old? Bristol, United Kingdom Bristol University Press.
Kurten, L., Dietzel, N., Kolominsky-Rabas, P. L., & Graessel, E. (2021). Predictors of the one-year-change in depressiveness in informal caregivers of community-dwelling people with dementia. BMC Psychiatry, 21(1), 177. doi:10.1186/s12888-021-03164-8
Kwan, M.-P. (2012). The Uncertain Geographic Context Problem. Annals of the Association of American Geographers, 102(5), 958-968. doi:10.1080/00045608.2012.687349
Lin, S. Y., & Lewis, F. M. (2015). Dementia Friendly, Dementia Capable, And Dementia Positive: Concepts To Prepare For The Future. Gerontologist, 55(2), 237-244. doi:10.1093/geront/gnu122
Lo, R. Y. (2017). The borderland between normal aging and dementia. Ci Ji Yi Xue Za Zhi, 29(2), 65-71. doi:10.4103/tcmj.tcmj_18_17
Manthorpe, J., & Iliffe, S. (2020). Muddling along in the city: Framing the cityscape of dementia. Dementia (London), 19(7), 2184-2198. doi:10.1177/1471301218817451
McFadden, S. (2021). Dementia-Friendly Communities: Why We Need Them and How We Can Create Them. Great Britain: Jessica Kingsley Publishers.
Mitchell, L., & Burton, E. (2006). Neighbourhoods for life: Designing dementia‐friendly outdoor environments. Quality in Ageing and Older Adults, 7(1), 26-33. doi:10.1108/14717794200600005
Mitchell, L., Burton, E., Raman, S., Blackman, T., Jenks, M., & Williams, K. (2003). Making the outside World Dementia-Friendly: Design Issues and Considerations. Environment and Planning B: Planning and Design, 30(4), 605-632. doi:10.1068/b29100
Rote, S. M., Angel, J. L., & Markides, K. (2017). Neighborhood Context, Dementia Severity, and Mexican American Caregiver Well-Being. J Aging Health, 29(6), 1039-1055. doi:10.1177/0898264317707141
Shareck, M., Alexander, S., & Glenn, N. M. (2021). In-situ at a distance? challenges and opportunities for health and place research methods in a post-COVID-19 world. Health Place, 69, 102572. doi:10.1016/j.healthplace.2021.102572
Sheehan, B., Burton, E., & Mitchell, L. (2006). Outdoor wayfinding in dementia. Dementia, 5(2), 271-281. doi:10.1177/1471301206062254
Silverman, M. (2019). 'We have different routes for different reasons': Exploring the purpose of walks for carers of people with dementia. Dementia (London), 18(2), 630-643. doi:10.1177/1471301217699677
Sturge, J., Nordin, S., Sussana Patil, D., Jones, A., Legare, F., Elf, M., & Meijering, L. (2021). Features of the social and built environment that contribute to the well-being of people with dementia who live at home: A scoping review. Health Place, 67, 102483. doi:10.1016/j.healthplace.2020.102483
Takechi, H., Sugihara, Y., Matsumoto, H., & Yamada, H. (2018). A Dementia Cafe as a Bridgehead for Community-Inclusive Care: Qualitative Analysis of Observations by On-the-Job Training Participants in a Dementia Cafe. Dement Geriatr Cogn Disord, 46(3-4), 128-139. doi:10.1159/000492174
Tariq, S., & Woodman, J. (2013). Using mixed methods in health research. JRSM Short Rep, 4(6), 2042533313479197. doi:10.1177/2042533313479197
Trivic, Z., & Low, K. (2021). Studying Multi-Sensory Neighbourhoods and Ageing-Friendly Design: Methodological Propositions. In X. Bonnaud & V. Fraigneau (Eds.), Nouveaux territoires de l'expérience olfactive (New Territories of the Olfactory Experience) (pp. 179-196). Gollion: Infolio.
Tsoy, E., Kiekhofer, R. E., Guterman, E. L., Tee, B. L., Windon, C. C., Dorsman, K. A., . . . Possin, K. L. (2021). Assessment of Racial/Ethnic Disparities in Timeliness and Comprehensiveness of Dementia Diagnosis in California. JAMA Neurol. doi:10.1001/jamaneurol.2021.0399
Wiersma, E. C., & Denton, A. (2016). From social network to safety net: Dementia-friendly communities in rural northern Ontario. Dementia (London), 15(1), 51-68. doi:10.1177/1471301213516118
Adekoya, A. A., & Guse, L. (2020). Wandering Behavior From the Perspectives of Older Adults With Mild to Moderate Dementia in Long-Term Care. Res Gerontol Nurs, 12(5), 239-247. doi:10.3928/19404921-20190522-01
Alcock, L., Galna, B., Hausdorff, J. M., Lord, S., & Rochester, L. (2020). Enhanced Obstacle Contrast to Promote Visual Scanning in Fallers with Parkinson's Disease: Role of Executive Function. Neuroscience, 436, 82-92. doi:10.1016/j.neuroscience.2020.03.032
Anderson, J., Flatt, J., Tree, J. J., Gross, A., & Rose, K. (2020). Leveraging Digital Methods to Engage Sexual and Gender Minority Caregivers of People With Dementia. Innovation in Aging, 4(S1). doi:10.1093/geroni/igaa057.2775
Biglieri, S. (2017). Implementing Dementia-Friendly Land Use Planning: An Evaluation of Current Literature and Financial Implications for Greenfield Development in Suburban Canada. Planning Practice & Research, 1-27. doi:10.1080/02697459.2017.1379336
Brorsson, A., Ohman, A., Lundberg, S., Cutchin, M. P., & Nygard, L. (2020). How accessible are grocery shops for people with dementia? A qualitative study using photo documentation and focus group interviews. Dementia (London), 19(6), 1872-1888. doi:10.1177/1471301218808591
Canevelli, M., Valletta, M., Trebbastoni, A., Sarli, G., D'Antonio, F., Tariciotti, L., . . . Bruno, G. (2016). Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches. Front Med (Lausanne), 3, 73. doi:10.3389/fmed.2016.00073
Courtney-Pratt, H., Mathison, K., & Doherty, K. (2018). Distilling authentic community-led strategies to support people with dementia to live well. Community Development, 49(4), 432-449. doi:10.1080/15575330.2018.1481443
Creswell, J. W., Klassen, A. C., Plano Clark, V. L., & Smith, K. C. (2011). Best Practices for Mixed Methods Research in the Health Sciences. Washington, DC: Office of Behavioral Social Sciences Research.
Davis, S., Byers, S., Nay, R., & Koch, S. (2009). Guiding design of dementia friendly environments in residential care settings: Considering the living experiences. Dementia, 8(2), 185-203. doi:10.1177/1471301209103250
Epps, F., Weeks, G., Graham, E., & Luster, D. (2018). Challenges to aging in place for African American older adults living with dementia and their families. Geriatr Nurs, 39(6), 646-652. doi:10.1016/j.gerinurse.2018.04.018
Evans, J., & Jones, P. (2011). The Walking Interview: Methodology, Mobility And Place. Applied Geography, 31(2), 849-858. doi:10.1016/j.apgeog.2010.09.005
Finlay, J., Esposito, M., Tang, S., Gomez-Lopez, I., Sylvers, D., Judd, S., & Clarke, P. (2020). Fast-food for thought: Retail food environments as resources for cognitive health and wellbeing among aging Americans? Health Place, 64, 102379. doi:10.1016/j.healthplace.2020.102379
Finlay, J. M. (2017). 'Walk like a penguin': Older Minnesotans' experiences of (non)therapeutic white space. Soc Sci Med, 198, 77-84. doi:10.1016/j.socscimed.2017.12.024
Finlay, J. M., & Bowman, J. A. (2017). Geographies on the Move: A Practical and Theoretical Approach to the Mobile Interview. The Professional Geographer, 69(2), 263-274. doi:10.1080/00330124.2016.1229623
Finlay, J. M., Gaugler, J. E., & Kane, R. L. (2018). Ageing in the margins: expectations of and struggles for ‘a good place to grow old’ among low-income older Minnesotans. Ageing & Society, 40(4), 759-783. doi:https://doi.org/10.1017/S0144686X1800123X
Galster, G. C. (2019). Making Our Neighborhoods, Making Our Selves. Chicago, IL: University of Chicago Press.
Gan, D. R. Y., Chaudhury, H., Mann, J., & Wister, A. V. (2021). Dementia-friendly neighbourhood and the built environment: A scoping review. Gerontologist. doi:10.1093/geront/gnab019
Garrett, M. D., Baldridge, D., Benson, W., Crowder, J., & Aldrich, N. (2015). Mental health disorders among an invisible minority: depression and dementia among american Indian and alaska native elders. Gerontologist, 55(2), 227-236. doi:10.1093/geront/gnu181
Grzeschik, R., Conroy-Dalton, R., Innes, A., Shanker, S., & Wiener, J. M. (2019). The contribution of visual attention and declining verbal memory abilities to age-related route learning deficits. Cognition, 187, 50-61. doi:10.1016/j.cognition.2019.02.012
Guo, Y., Chan, C. H., Chang, Q., Liu, T., & Yip, P. S. F. (2019). Neighborhood environment and cognitive function in older adults: A multilevel analysis in Hong Kong. Health Place, 58, 102146. doi:10.1016/j.healthplace.2019.102146
Hipp, J. R., Faris, R. W., & Boessen, A. (2012). Measuring ‘neighborhood’: Constructing network neighborhoods. Social Networks, 34(1), 128-140. doi:10.1016/j.socnet.2011.05.002
Hulko, W. (2016). LGBT* individuals and dementia: an intersectional approach. In S. Westwood & E. Price (Eds.), Lesbian, Gay, Bisexual and Trans* Individuals Living with Dementia (pp. 55-70). Milton Park, Oxfordshire: Routledge.
Hunt, D., Stuart, S., Nell, J., Hausdorff, J. M., Galna, B., Rochester, L., & Alcock, L. (2018). Do people with Parkinson's disease look at task relevant stimuli when walking? An exploration of eye movements. Behav Brain Res, 348, 82-89. doi:10.1016/j.bbr.2018.03.003
Igarashi, A., Matsumoto, H., Takaoka, M., Kugai, H., Suzuki, M., Murata, S., . . . Yamamoto‐Mitani, N. (2020). Community‐based participatory approach to promote convenience stores’ support for older adults with dementia in Japan. Alzheimer's & Dementia, 16(S8). doi:10.1002/alz.039157
Innes, A., Morgan, D., & Farmer, J. (Eds.). (2020). Remote and Rural Dementia Care: Policy, Research and Practice. Great Britain: Policy Press.
Jeffres, L. W., Bracken, C. C., Jian, G., & Casey, M. F. (2009). The Impact of Third Places on Community Quality of Life. Applied Research in Quality of Life, 4(4), 333-345. doi:10.1007/s11482-009-9084-8
Kallitsis, P., Soilemezi, D., & Elliott, A. M. (2019). Disabling Spaces and Spatial Strategies: Feminist Approaches to the Home Environment of Family Caregivers of People with Dementia. Home Cultures, 15(3), 265-287. doi:10.1080/17406315.2018.1690293
Keady, J., Campbell, S., Barnes, H., Ward, R., Li, X., Swarbrick, C., . . . Elvish, R. (2012). Neighbourhoods and dementia in the health and social care context: a realist review of the literature and implications for UK policy development. Reviews in Clinical Gerontology, 22(2), 150-163. doi:10.1017/s0959259811000268
Keating, N. (Ed.) (2008). Rural ageing: A good place to grow old? Bristol, United Kingdom Bristol University Press.
Kurten, L., Dietzel, N., Kolominsky-Rabas, P. L., & Graessel, E. (2021). Predictors of the one-year-change in depressiveness in informal caregivers of community-dwelling people with dementia. BMC Psychiatry, 21(1), 177. doi:10.1186/s12888-021-03164-8
Kwan, M.-P. (2012). The Uncertain Geographic Context Problem. Annals of the Association of American Geographers, 102(5), 958-968. doi:10.1080/00045608.2012.687349
Lin, S. Y., & Lewis, F. M. (2015). Dementia Friendly, Dementia Capable, And Dementia Positive: Concepts To Prepare For The Future. Gerontologist, 55(2), 237-244. doi:10.1093/geront/gnu122
Lo, R. Y. (2017). The borderland between normal aging and dementia. Ci Ji Yi Xue Za Zhi, 29(2), 65-71. doi:10.4103/tcmj.tcmj_18_17
Manthorpe, J., & Iliffe, S. (2020). Muddling along in the city: Framing the cityscape of dementia. Dementia (London), 19(7), 2184-2198. doi:10.1177/1471301218817451
McFadden, S. (2021). Dementia-Friendly Communities: Why We Need Them and How We Can Create Them. Great Britain: Jessica Kingsley Publishers.
Mitchell, L., & Burton, E. (2006). Neighbourhoods for life: Designing dementia‐friendly outdoor environments. Quality in Ageing and Older Adults, 7(1), 26-33. doi:10.1108/14717794200600005
Mitchell, L., Burton, E., Raman, S., Blackman, T., Jenks, M., & Williams, K. (2003). Making the outside World Dementia-Friendly: Design Issues and Considerations. Environment and Planning B: Planning and Design, 30(4), 605-632. doi:10.1068/b29100
Rote, S. M., Angel, J. L., & Markides, K. (2017). Neighborhood Context, Dementia Severity, and Mexican American Caregiver Well-Being. J Aging Health, 29(6), 1039-1055. doi:10.1177/0898264317707141
Shareck, M., Alexander, S., & Glenn, N. M. (2021). In-situ at a distance? challenges and opportunities for health and place research methods in a post-COVID-19 world. Health Place, 69, 102572. doi:10.1016/j.healthplace.2021.102572
Sheehan, B., Burton, E., & Mitchell, L. (2006). Outdoor wayfinding in dementia. Dementia, 5(2), 271-281. doi:10.1177/1471301206062254
Silverman, M. (2019). 'We have different routes for different reasons': Exploring the purpose of walks for carers of people with dementia. Dementia (London), 18(2), 630-643. doi:10.1177/1471301217699677
Sturge, J., Nordin, S., Sussana Patil, D., Jones, A., Legare, F., Elf, M., & Meijering, L. (2021). Features of the social and built environment that contribute to the well-being of people with dementia who live at home: A scoping review. Health Place, 67, 102483. doi:10.1016/j.healthplace.2020.102483
Takechi, H., Sugihara, Y., Matsumoto, H., & Yamada, H. (2018). A Dementia Cafe as a Bridgehead for Community-Inclusive Care: Qualitative Analysis of Observations by On-the-Job Training Participants in a Dementia Cafe. Dement Geriatr Cogn Disord, 46(3-4), 128-139. doi:10.1159/000492174
Tariq, S., & Woodman, J. (2013). Using mixed methods in health research. JRSM Short Rep, 4(6), 2042533313479197. doi:10.1177/2042533313479197
Trivic, Z., & Low, K. (2021). Studying Multi-Sensory Neighbourhoods and Ageing-Friendly Design: Methodological Propositions. In X. Bonnaud & V. Fraigneau (Eds.), Nouveaux territoires de l'expérience olfactive (New Territories of the Olfactory Experience) (pp. 179-196). Gollion: Infolio.
Tsoy, E., Kiekhofer, R. E., Guterman, E. L., Tee, B. L., Windon, C. C., Dorsman, K. A., . . . Possin, K. L. (2021). Assessment of Racial/Ethnic Disparities in Timeliness and Comprehensiveness of Dementia Diagnosis in California. JAMA Neurol. doi:10.1001/jamaneurol.2021.0399
Wiersma, E. C., & Denton, A. (2016). From social network to safety net: Dementia-friendly communities in rural northern Ontario. Dementia (London), 15(1), 51-68. doi:10.1177/1471301213516118