Journal of Urban Design and Mental Health; 2021:7;1
EDITORIAL
Ageing and dementia-friendly urban design: New directions for interdisciplinary research
Daniel R. Y. Gan, PhD (1) and Zdravko Trivic, PhD (2)
(1) Gerontology Research Centre, Simon Fraser University, Vancouver, Canada
*Corresponding author: [email protected]
(2) Department of Architecture, National University of Singapore, Singapore
(1) Gerontology Research Centre, Simon Fraser University, Vancouver, Canada
*Corresponding author: [email protected]
(2) Department of Architecture, National University of Singapore, Singapore
Citation: Gan DRY, Trivic Z (2021). Ageing and dementia-friendly urban design: New directions for interdisciplinary research. Journal of Urban Design and Mental Health 7;1
Twenty years since Ray Forrest and Ade Kearns (2001) foregrounded the neighbourhood as “the receptacle for many of the informal resources of […] mutual aid and self-help, facilitated by a diversity of loose ties” (p. 2139) in their oft-cited article, we witnessed for the first time increasingly widespread phenomenon of neighbours helping neighbours (Jones et al., 2020). As the global COVID-19 pandemic reminded us of the importance of public spaces, social life and mutual care for mental and social health (Zandieh et al., 2020), membership in apps for neighbourhood social network surged (The Economist, 2020) and many offered their help to older neighbours and vulnerable persons, whether with grocery shopping or simply lifting their moods (Jones et al., 2020).
Ageing-friendly neighbourhoods?
This display of neighbourhood social capital (Hawkins & Maurer, 2010) or “emergency collectivism” (Katz, 1981, p. 136) highlights the protective effects of neighbourhood ties for mental health (Gan & Best, 2021) amid reports of loneliness and depression among some older adults (Krendl & Perry, 2020; Van Tilburg et al., 2020). They showed that psychosocial aspects of neighbourhood ties are important (Berkman et al., 2000; Gardner, 2011; Gan, 2017; Gan et al., 2021; Unger & Wandersman, 1985). The neighbourhood functions as a psychosocial “safety net” (Pescosolido, 2021, p. 344; Gan et al., 2021; Seifert, 2020). Older adults who established stronger ties with their neighbours coped better during the pandemic, and reported less loneliness, depression and memory complaints than others (Gan & Best, 2021).
But if we look closely into the studies cited above, a more complex picture emerges. Neighbourhoods and their communities are invariably limited in their capacity to deliver some desirable outcomes (Forrest & Kearns, 2001; Gan et al., 2021). Contact with neighbours are good for sociality and preventing loneliness, but less so for actual support and global wellbeing (Gardner, 2011; Seifert, 2020). Support often stops short along racial or socioeconomic fault lines (Hawkins & Maurer, 2010; Jones et al., 2020). Those who relied primarily on non-friend neighbours were more likely to remain lonely during the pandemic (Gan & Best, 2021).
Against this backdrop, it is no wonder that social scientists routinely caution against environmental determinism, especially in urban design and neighbourhood studies (Henriksen & Tjora, 2014, p. 2113). As much as urban designers and community planners are asking what can we do to advance social justice (Greenfield, 2018; Loukaitou-Sideris, 2020) and address health inequity (Arcaya et al., 2015; Mitchell et al., 2015) – especially in light of the disproportionate impact of COVID-19 on people and neighbourhoods of lower socio-economic statuses (Bambra et al., 2020; Cheshmehzangi, 2021; Jaspal & Breakwell, 2020) – the relationship between environmental and psychosocial factors needs to be thoroughly reconsidered to enable interdisciplinary research and context-sensitive interventions (Hohmann & Shear, 2002; Gan, 2017; 2020).
Thankfully, scholars have led the way in recalibrating the balance between environmental and psychosocial perspectives. Henriksen and Tjora (2014) reconciled the complexities of neighbourhood communities with the concept of affordance (cf. Chemero, 2003; Gan et al., 2020, p. 563). In their words, “although the physical conditions do not determine social life, they afford, or offer resources for, certain forms of social activities more than other” (Henriksen & Tjora, 2014, p. 2117, italics in original). This makes lived experience, which is simultaneously environmental and psychosocial, important (Antonovsky, 1996; Bhuyan et al, 2021; Trivic, 2021). Neighbourhood space users, which include many older adults, are agentic beings. Scholars of neighbourhood cohesion should not be too surprised to learn that older adults were more likely to receive and provide support, both of which improved mental health (Sin et al., 2021), or that some females may feel uncomfortable around neighbourhood spaces dominated by rowdy males (Wanka, 2018).
Dementia-friendly urban design?
Participatory approaches are often employed to centre and understand the lived experiences of people in different socio-economic and health statuses, including people living with dementia (e.g., Tulloch et al., 2021). Dementia is often misrepresented and misunderstood (Hilman & Latimer, 2017; Zeilig, 2014). According to a report commissioned by the Lancet, one third of all people aged 65 and older are likely to have dementia (Livingston et al., 2017, p. 2674). Although experiencing some degree of cognitive decline is common, dementia is best defined as cognitive decline that “affects activities of daily living or social functioning” to greater or lesser extent (Livingston et al., 2017, p. 2675). Persons with dementia (PWD) vary greatly in their abilities to care for oneself and are often able to engage socially. Some, including authors of this collection, may even engage in research as co-investigators.
The brain is a social organ (Cacioppo et al., 2014). Amid concerns around the health system impacts of neurological disabilities in global aging populations (Kyu et al., 2018), “brain health” has been discussed and defined, in part, as dementia and its protective factors with a preventive focus (Lincoln et al., 2014). Neurological processes of cognitive decline that could lead to dementia may begin as early as ten years prior to dementia onset (Bateman et al., 2012), e.g., due to hearing loss or depression (Livingston et al., 2017, pp. 2680-2681; cf. Alexopoulos, 2003; Lin & Albert, 2014; Singh-Manoux et al., 2017). Alzheimer’s disease could be “a clinically silent disorder starting in mid-life” (Livingston et al., 2017, p. 2686; cf. Ritchie et al., 2016).
That said, 40% of known risk factors for developing dementia are modifiable (Livingston et al., 2020). Given that dementia onset most typically occur after age 65 and that interventions to delay dementia have not been found effective upon the onset of mild cognitive impairment, preventive non-pharmacological efforts should begin as early as age 55 (Livingston et al., 2017; Sikkes et al., 2020). To prevent dementia, scholars called for “risk factor modification for whole populations or high-risk populations,” which includes “increasing education in early life, increasing physical activity and social engagement” (Livingston et al., 2017, p. 2686). Social contact in the neighborhood may maintain cognitive reserve, especially in early stages, and slow dementia progression (Clarke et al., 2012; Ertel et al., 2008).
Translational design research
The mental health needs of diverse older adults provide new impetus for systematic and collaborative contributions from urban designers and scholars. Differences in disciplinary norms can present significant – but surmountable – challenges in the course of knowledge production. Pitfalls are numerous (Lawhon, 2009; Oakes et al., 2015). To overcome these challenges, thorough understanding across disciplines are required.
The articles in this Edition showcases areas of interdisciplinary synergies and the possibilities of a new direction in ageing- and dementia-friendly urban design that emphasizes the everyday experiences of various populations and how urban design elements and/or third places contribute to the pathways to mental health (Diez Roux & Mair, 2010) for translations into design and community development practices (Diez Roux, 2016). We especially sought contributions on spatial (dis)orientation and multi-sensorial approaches (Gan et al., 2021; Trivic & Low, 2020), on the premise that everyday cognitive resilience, i.e., one’s psychosocial ability to benefit from everyday stimuli, may enhance cognitive reserve and mitigate the effects of unequal educational opportunities in early life.
Consistent with the themes of participatory research and lived experiences, several important questions are addressed in this collection. First, who is doing ageing related research? Ng and Zhang (2021) urged designers to better value the inputs of older adults in matters that concern their health. Rohra, Mann, and colleagues (2021) take this a notch further and proposed participatory co-research on way-finding, demonstrating how we can have people with dementia steer research for people with dementia. These self-reflexive approaches are ground-breaking.
Second, how are current the research conducted? How successful are these methods? Vatanpour (2021) examined the differences in brain waves in response to images of different urban parks using electroencephalogram (EEG). Iravani and colleagues (2021) shed light on the association between mixed-use urban form and the mental wellbeing of older adults, using survey instruments. Luscombe and Boyce (2021) developed a scale to measure and advance the implementation of dementia-friendly streetscapes. Integrating these diverse methods to answer new research questions will be challenging. Finlay and Meltzer (2021) shared brief but critical methodological insights, and opportunities for future research.
Third, how can rich interdisciplinary evidence be translated into design and community development practices? What evidences are required? Gan, Zhang, and Ng (2021) advocated for “research-by-design”, while pointing out the opportunities for design studios to systematically generate and test design solutions that may support activities that prevent cognitive decline. Tan and colleagues (2021) demonstrated how systematic observations of sensory stimuli and activities in neighbourhood public spaces could yield supportive interventions, drawing on concepts of synaesthesia.
Finally, this Edition features an interesting design proposal by Zhu and colleagues (2021), which combines augmented reality with the sensorial experience of China’s square dance to foster intergenerational relationship. Moore and Vitale (2021) presented us with Sydney’s valiant efforts to create ageing-friendly urban design that promotes mental health at the population level. Also featured is a case study of Lagos (Akindejoye et al., 2021). We are thoroughly pleased to announce and share a review of Roe and McCay’s (2021) new book Restorative Cities (Grove, 2021).
Propelling ageing- and dementia-friendly urban design forward will require concerted efforts from diverse expertise. We thank all authors for their work and valuable contributions. We also like to thank our eminent panel of reviewers for their critical and helpful inputs, without whom the success of this Edition would not be possible. Future Summer Editions on Ageing may focus on adolescents, and/or interdisciplinary interventions based on the mental health effects of natural neighbourhood networks (Gardner, 2011) and neighbourhood atmosphere (Gan et al., 2021) through the “process model of constructive ageing” (Scharlach, 2017). Suggestions are welcome.
Ageing-friendly neighbourhoods?
This display of neighbourhood social capital (Hawkins & Maurer, 2010) or “emergency collectivism” (Katz, 1981, p. 136) highlights the protective effects of neighbourhood ties for mental health (Gan & Best, 2021) amid reports of loneliness and depression among some older adults (Krendl & Perry, 2020; Van Tilburg et al., 2020). They showed that psychosocial aspects of neighbourhood ties are important (Berkman et al., 2000; Gardner, 2011; Gan, 2017; Gan et al., 2021; Unger & Wandersman, 1985). The neighbourhood functions as a psychosocial “safety net” (Pescosolido, 2021, p. 344; Gan et al., 2021; Seifert, 2020). Older adults who established stronger ties with their neighbours coped better during the pandemic, and reported less loneliness, depression and memory complaints than others (Gan & Best, 2021).
But if we look closely into the studies cited above, a more complex picture emerges. Neighbourhoods and their communities are invariably limited in their capacity to deliver some desirable outcomes (Forrest & Kearns, 2001; Gan et al., 2021). Contact with neighbours are good for sociality and preventing loneliness, but less so for actual support and global wellbeing (Gardner, 2011; Seifert, 2020). Support often stops short along racial or socioeconomic fault lines (Hawkins & Maurer, 2010; Jones et al., 2020). Those who relied primarily on non-friend neighbours were more likely to remain lonely during the pandemic (Gan & Best, 2021).
Against this backdrop, it is no wonder that social scientists routinely caution against environmental determinism, especially in urban design and neighbourhood studies (Henriksen & Tjora, 2014, p. 2113). As much as urban designers and community planners are asking what can we do to advance social justice (Greenfield, 2018; Loukaitou-Sideris, 2020) and address health inequity (Arcaya et al., 2015; Mitchell et al., 2015) – especially in light of the disproportionate impact of COVID-19 on people and neighbourhoods of lower socio-economic statuses (Bambra et al., 2020; Cheshmehzangi, 2021; Jaspal & Breakwell, 2020) – the relationship between environmental and psychosocial factors needs to be thoroughly reconsidered to enable interdisciplinary research and context-sensitive interventions (Hohmann & Shear, 2002; Gan, 2017; 2020).
Thankfully, scholars have led the way in recalibrating the balance between environmental and psychosocial perspectives. Henriksen and Tjora (2014) reconciled the complexities of neighbourhood communities with the concept of affordance (cf. Chemero, 2003; Gan et al., 2020, p. 563). In their words, “although the physical conditions do not determine social life, they afford, or offer resources for, certain forms of social activities more than other” (Henriksen & Tjora, 2014, p. 2117, italics in original). This makes lived experience, which is simultaneously environmental and psychosocial, important (Antonovsky, 1996; Bhuyan et al, 2021; Trivic, 2021). Neighbourhood space users, which include many older adults, are agentic beings. Scholars of neighbourhood cohesion should not be too surprised to learn that older adults were more likely to receive and provide support, both of which improved mental health (Sin et al., 2021), or that some females may feel uncomfortable around neighbourhood spaces dominated by rowdy males (Wanka, 2018).
Dementia-friendly urban design?
Participatory approaches are often employed to centre and understand the lived experiences of people in different socio-economic and health statuses, including people living with dementia (e.g., Tulloch et al., 2021). Dementia is often misrepresented and misunderstood (Hilman & Latimer, 2017; Zeilig, 2014). According to a report commissioned by the Lancet, one third of all people aged 65 and older are likely to have dementia (Livingston et al., 2017, p. 2674). Although experiencing some degree of cognitive decline is common, dementia is best defined as cognitive decline that “affects activities of daily living or social functioning” to greater or lesser extent (Livingston et al., 2017, p. 2675). Persons with dementia (PWD) vary greatly in their abilities to care for oneself and are often able to engage socially. Some, including authors of this collection, may even engage in research as co-investigators.
The brain is a social organ (Cacioppo et al., 2014). Amid concerns around the health system impacts of neurological disabilities in global aging populations (Kyu et al., 2018), “brain health” has been discussed and defined, in part, as dementia and its protective factors with a preventive focus (Lincoln et al., 2014). Neurological processes of cognitive decline that could lead to dementia may begin as early as ten years prior to dementia onset (Bateman et al., 2012), e.g., due to hearing loss or depression (Livingston et al., 2017, pp. 2680-2681; cf. Alexopoulos, 2003; Lin & Albert, 2014; Singh-Manoux et al., 2017). Alzheimer’s disease could be “a clinically silent disorder starting in mid-life” (Livingston et al., 2017, p. 2686; cf. Ritchie et al., 2016).
That said, 40% of known risk factors for developing dementia are modifiable (Livingston et al., 2020). Given that dementia onset most typically occur after age 65 and that interventions to delay dementia have not been found effective upon the onset of mild cognitive impairment, preventive non-pharmacological efforts should begin as early as age 55 (Livingston et al., 2017; Sikkes et al., 2020). To prevent dementia, scholars called for “risk factor modification for whole populations or high-risk populations,” which includes “increasing education in early life, increasing physical activity and social engagement” (Livingston et al., 2017, p. 2686). Social contact in the neighborhood may maintain cognitive reserve, especially in early stages, and slow dementia progression (Clarke et al., 2012; Ertel et al., 2008).
Translational design research
The mental health needs of diverse older adults provide new impetus for systematic and collaborative contributions from urban designers and scholars. Differences in disciplinary norms can present significant – but surmountable – challenges in the course of knowledge production. Pitfalls are numerous (Lawhon, 2009; Oakes et al., 2015). To overcome these challenges, thorough understanding across disciplines are required.
The articles in this Edition showcases areas of interdisciplinary synergies and the possibilities of a new direction in ageing- and dementia-friendly urban design that emphasizes the everyday experiences of various populations and how urban design elements and/or third places contribute to the pathways to mental health (Diez Roux & Mair, 2010) for translations into design and community development practices (Diez Roux, 2016). We especially sought contributions on spatial (dis)orientation and multi-sensorial approaches (Gan et al., 2021; Trivic & Low, 2020), on the premise that everyday cognitive resilience, i.e., one’s psychosocial ability to benefit from everyday stimuli, may enhance cognitive reserve and mitigate the effects of unequal educational opportunities in early life.
Consistent with the themes of participatory research and lived experiences, several important questions are addressed in this collection. First, who is doing ageing related research? Ng and Zhang (2021) urged designers to better value the inputs of older adults in matters that concern their health. Rohra, Mann, and colleagues (2021) take this a notch further and proposed participatory co-research on way-finding, demonstrating how we can have people with dementia steer research for people with dementia. These self-reflexive approaches are ground-breaking.
Second, how are current the research conducted? How successful are these methods? Vatanpour (2021) examined the differences in brain waves in response to images of different urban parks using electroencephalogram (EEG). Iravani and colleagues (2021) shed light on the association between mixed-use urban form and the mental wellbeing of older adults, using survey instruments. Luscombe and Boyce (2021) developed a scale to measure and advance the implementation of dementia-friendly streetscapes. Integrating these diverse methods to answer new research questions will be challenging. Finlay and Meltzer (2021) shared brief but critical methodological insights, and opportunities for future research.
Third, how can rich interdisciplinary evidence be translated into design and community development practices? What evidences are required? Gan, Zhang, and Ng (2021) advocated for “research-by-design”, while pointing out the opportunities for design studios to systematically generate and test design solutions that may support activities that prevent cognitive decline. Tan and colleagues (2021) demonstrated how systematic observations of sensory stimuli and activities in neighbourhood public spaces could yield supportive interventions, drawing on concepts of synaesthesia.
Finally, this Edition features an interesting design proposal by Zhu and colleagues (2021), which combines augmented reality with the sensorial experience of China’s square dance to foster intergenerational relationship. Moore and Vitale (2021) presented us with Sydney’s valiant efforts to create ageing-friendly urban design that promotes mental health at the population level. Also featured is a case study of Lagos (Akindejoye et al., 2021). We are thoroughly pleased to announce and share a review of Roe and McCay’s (2021) new book Restorative Cities (Grove, 2021).
Propelling ageing- and dementia-friendly urban design forward will require concerted efforts from diverse expertise. We thank all authors for their work and valuable contributions. We also like to thank our eminent panel of reviewers for their critical and helpful inputs, without whom the success of this Edition would not be possible. Future Summer Editions on Ageing may focus on adolescents, and/or interdisciplinary interventions based on the mental health effects of natural neighbourhood networks (Gardner, 2011) and neighbourhood atmosphere (Gan et al., 2021) through the “process model of constructive ageing” (Scharlach, 2017). Suggestions are welcome.
About the Authors
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Daniel R. Y. Gan, PhD is a community gerontologist at Simon Fraser University, Vancouver. He conducts research at the intersection of planning, psychology and gerontology to improve the cognitive health of older adults living in community. He developed a Transdisciplinary Neighbourhood Health Framework which is the basis of current work on neighbourhood cohesion, loneliness and dementia prevention.
@daniel_gry |
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Zdravko Trivic, PhD is Assistant Professor at the Department of Architecture, School of Design and Environment, National University of Singapore. His research interests include: multi-sensorial urbanism, health-supportive and ageing-friendly neighbourhood design, urban space in high-density contexts, creative placemaking and community participation.
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References
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Trivic, Z. (2021). A study of older adults’ perception of high-density housing neighbourhoods in Singapore: Multi-sensory perspective. International Journal of Environmental Research and Public Health, 18(13), 6880. doi: https://doi.org/10.3390/ ijerph18136880.
Trivic, Z., & Low, K.E.Y. (2021). Studying multi-sensory neighbourhoods and ageing-friendly design: Methodological propositions. In Bonnaud, X., & Fraigneau, V. (Eds.), Nouveaux Territoires De L’expérience Olfactive. pp. 179–196. Gollion: Infolio.
Tulloch, K., McCaul, T., & Scott, T. L. (2021). Positive Aspects of Dementia Caregiving During the COVID-19 Pandemic. Clin Gerontol, 1-11. doi:10.1080/07317115.2021.1929630
Unger, D. G., & Wandersman, A. (1985). The importance of neighbors: The social, cognitive, and affective components of neighboring. American journal of community psychology, 13(2), 139-169.
Van Tilburg, T. G., Steinmetz, S., Stolte, E., van der Roest, H., & de Vries, D. H. (2020). Loneliness and mental health during the COVID-19 pandemic: A study among Dutch older adults. The Journals of Gerontology: Series B.
Wanka, A., 2018. Disengagement as withdrawal from public space: rethinking the relation between place attachment, place appropriation, and identity-building among older adults. Gerontologist, 58(1), 130–139.
Zandieh, R., Nieuwenhuijsen, M., & Zandieh, M. (2020). Adaptability of Public Spaces and Mental Health Inequalities during the COVID-19 Pandemic. The Journal of Urban Design and Mental Health, 6(5).Zeilig, H. (2014). Dementia as a cultural metaphor. The Gerontologist, 54(2), 258-267. https://doi.org/10.1093/geront/gns203
Zhu, Y., Zhang, Y., Wang, Y., & Trivic, Z. (2021). The Square Dance in China: How Sensory Design Can Foster Inter-Generational Interaction and Improve Older Adults’ Wellbeing. Journal of Urban Design and Mental Health, 7;7.