A dementia-friendly outdoor space

Losing your way, being obstructed by lampposts and nowhere to rest. When you no longer know and can't see it all, a walk through the neighborhood is no longer so obvious. While a stroll can do people so much good. Commissioned by the municipality of Wijk bij Duurstede and Stichting QuaRijn and in collaboration with Alzheimer's Netherlands, among others, Studio id+ developed a dementia-friendly outdoor space through the neighborhood. The pilot serves not only to make the neighborhood accessible for residents of the Ewoud & Elisabeth Hospital, but also to give local residents with dementia a foothold in their immediate living environment. After all, the neighborhood is an inseparable part of your home.

Wijk bij Duurstede is one of the fastest aging municipalities in the Netherlands and the number of people with dementia, including those living at home, is increasing rapidly. According to calculations by Alzheimer Nederland, the number will rise from 320 in 2020 to 850 people in 2040. Throughout the Netherlands, 300,000 people have dementia, more than 80,000 of whom live in nursing or care homes. In addition, it is estimated that there are some 100,000 people who have not yet been diagnosed. Anja Dirks, owner, architect and interior designer at Studio id+: "For people with dementia living in a residential care facility, it is difficult or even impossible to go outside independently. Often there is a private outdoor space in the form of a balcony or enclosed garden, but independently exploring the surroundings is, for understandable safety reasons, virtually impossible."

At the same time, the "Pressure and Coercion" law that came into effect in 2020 defines that residents of a residential care facility should also have as much freedom as possible. Moreover, for people living at home with dementia, finding their way (back), even in familiar surroundings, is increasingly difficult. This not only makes the person anxious, but also causes family and informal caregivers to worry about safety. While going for a walk is so good for a person. Jan Kuiper, alderman of the municipality of Wijk bij Duurstede: "The municipality sees the walking routes at the Ewoud & Elisabeth Hospital as a pilot project to enable more people with memory problems to walk independently. With the construction of a second nursing home unit in Wijk bij Duurstede, its importance will increase even further. The municipal handbook Inrichting Openbare Buitenruimte will also be adjusted accordingly."

Stichting QuaRijn took a broad view of the urgency and looked at how residents from an intramural setting without an enclosed garden could still go outside. How, initially under supervision, they could take a stroll in the neighborhood and what forms of support would make it possible for residents of care institutions who are able to do so to do so independently. Studio id+ was asked to look for methods to enable people from the Ewoud & Elisabeth Hospital to walk safely through the neighborhood and at the same time give the municipality tools to make the neighborhood more accessible and friendly for people with dementia. In addition, the municipality and QuaRijn want to normalize encountering people with confused behavior on the street. It is important that this too goes smoothly and safely. Not only QuaRijn Foundation, as a care organization, was closely involved in the research, but also Alzheimer Nederland and other stakeholders provided input and reflection on the results through a user group.  

Before Studio id+ began designing, the designers developed a customized research methodology. In four levels - accessibility (physical), spatial (support), social (awareness) and digital (technology) - insight is provided into how we generally orient ourselves in the outdoor space and what support can contribute to this. Dirks: "In addition to mapping out physical components that can increase barriers, such as curbs, transitions, fences and contrast, we also looked at which 'markers' can in fact provide orientation. And how home automation and awareness in the neighborhood can best support someone with dementia."

Based on the research Studio id+ was able to give advice and design a dementia-friendly route in the neighborhood from the main entrance of the Ewoud & Elisabeth Gasthuis to the center of Wijk bij Duurstede. On this route several adjustments were made to help the residents of the guest house and local residents with dementia and other memory problems with orientation and navigation and to make the neighborhood safer. The various options and the final route were also tested with residents. In doing so, QuaRijn, as a care organization, makes a strong case for residents' ability to learn and eventually walk the route independently. 

One of the design interventions to encourage people with dementia to take a walk independently are the distinctive yellow footsteps from the entrance of the Ewoud & Elisabeth Guest House to the center and back again. "Because many elderly people with dementia orient themselves on the ground, they will follow the footsteps. Anyway, following a route is part of our basic orientation." In addition to indicating the route, the footsteps also improve the visibility of the entrance to the care facility. The yellow color stands out well in the environment and also makes them visible to people with impaired vision, something often associated with dementia. 

A bench has been placed at the end of the route so residents can take a rest along the way. From there, they can continue their way to the center or return home. The exact location of the benches was based on the average distance the elderly can travel in one stretch. Dirks: "In addition to placing a new bench, existing furnishing elements were also adjusted. For example, lampposts that were in the middle of the sidewalk were moved, because it was difficult to pass each other - and even impossible with a walker. In addition, colored tiles make a clearer distinction between the sidewalk and bike path, and part of the sidewalk has been moved so that cyclists can use it less easily to cut off. In cooperation with the municipality, we converted the advice and partial designs into a concrete plan, which was realized shortly afterwards." 

The exercise garden next to the Ewoud & Elisabeth Hospital was also redesigned, as people with dementia and impaired vision can experience empty planting areas as an eerie black hole.

Studio id+ developed two routes: one to the center and one in the immediate vicinity of the Ewoud & Elisabeth Hospital. The first route was opened as a pilot on April 24, 2024 during the first Wijkse Wandel3daagse for the elderly. With as many as two hundred participants, this was a great success. Based on the results of the pilot, the second route will be realized later this year.