Dementia-friendly places benefit us all – so we should start planning for them

David Cameron (remember him?) speaking about dementia in 2013. Image: Getty.

Dementia is an issue that touches everyone. With an estimated 850,000 people living with dementia in the UK today, we all have family and friends who have been affected by this most serious and debilitating illness, with its wide ranging and often misunderstood symptoms.

During his premiership, David Cameron launched the “Dementia Challenge”, which aimed to find a treatment or cure by 2025. We certainly hope that his presidency of Alzheimer’s Research UK, announced last week, will help the medical world meet this immense challenge.

But while we wait for the cure, life goes on for many people living with the disease. And there is a more immediate and more achievable outcome we can do something about: improving the environment to help people live well and independently longer. 

Public interest in wanting to contribute to support and improve the lives of people living with dementia is shown by the fact 215 local communities have already signed up to become Dementia Friendly Communities. This initiative, established by Alzheimer’s Society, galvanises local efforts and support.

While still in the early stages attention is now turning to how the local built environment can impact on the quality of people living with dementia and help them to maintain their independence for longer.

Dementia and Town Planning, new practice advice published this week by the Royal Town Planning Institute (RTPI) and endorsed by Alzheimer’s Society, demonstrates how good planning can create better environments for people living with dementia. It argues that, if you get an area right for people living with dementia, you also get it right for all older people, for young disabled people, for families with small children – and ultimately for everyone.


So what can town planning contribute? Rather a lot.

Commitment: The RTPI award-winning Plymouth Plan 2011-2031 includes the ambition to become a dementia friendly city by 2031, starting with an audit whether the city’s communities have access to the services they require. It is one of the few councils that has adopted plans that explicitly mention dementia. If more can do the same it would be a good start. 

Detail: Worcestershire County Council have worked with planners from the three South Worcestershire Councils to develop a draft Planning for Health Supplementary Planning Document which contains sections dedicated to “age friendly environments and dementia”. They give urban design advice to create areas that meet the needs of people living with dementia.

Using available tools: As part of Belfast’s successful application to become a World Health Organization age-friendly city it developed an assessment tool to gauge how accessible the built environment is for older people. It carried out walks with people with dementia living in supported housing to gain their opinions and use their experience of the walking environment in their area.  

Asking people with dementia what they need: In Bradford, the Face it Together group is wholly led by people with dementia. They have provided feedback on signage and accessibility, and advised on both a hospital refurbishment and the planning of a Westfield Shopping Centre.

A little bit of lateral thinking: That’s is something planners are good at. As part of a scheme to improve the Conservation Area of the small town of Kirriemuir, Angus council have worked with the Dementia Friendly Kirriemuir Project. The council gave planning permission for the change of use for a piece of derelict land to become a dementia friendly garden with a rent of £1.00 per year. The garden will be is a safe, friendly, outdoor space that people living with dementia and the local community can enjoy.

Aiming for the best: Hogeweyk Village, Netherlands is recognised as a world leader in the design of the facilities and care for its 152 residents living with dementia. They live in groups in 23 specially designed houses. The village has streets, squares, gardens, a park and a range of shops and restaurants where the residents move around independently and safely. These facilities can be used by both Hogeweyk residents and people from the surrounding area.

I have to confess to having rather a vested interest in all of this. I have had ME, an invisible and often misunderstood illness for most of my adult life, and like dementia it affects both my physical health and my cognitive functioning. I have decided to make my home in London, a wonderful city in many ways but quite unforgiving on those who find it more difficult to move around. Try negotiating the multiple escalators and steps of Canary Wharf with a pushchair and an inquisitive toddler. Exhausting doesn’t cover it.

So my point is; if we create places that are suitable to meet the needs of people living with dementia, they will be that little bit kinder for all of us to use.

Sarah Lewis is planning practice officer at the Royal Town Planning Institute.

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How bad is the air pollution on the average subway network?

The New York Subway. Image: Getty.

Four more major Indian cities will soon have their own metro lines, the country’s government has announced. On the other side of the Himalayas, Shanghai is building its 14th subway line, set to open in 2020, adding 38.5 km and 32 stations to the world’s largest subway network. And New Yorkers can finally enjoy their Second Avenue Subway line after waiting for almost 100 years for it to arrive.

In Europe alone, commuters in more than 60 cities use rail subways. Internationally, more than 120m people commute by them every day. We count around 4.8m riders per day in London, 5.3m in Paris, 6.8m in Tokyo, 9.7m in Moscow and 10m in Beijing.

Subways are vital for commuting in crowded cities, something that will become more and more important over time – according to a United Nations 2014 report, half of the world’s population is now urban. They can also play a part in reducing outdoor air pollution in large metropolises by helping to reduce motor-vehicle use.

Large amounts of breathable particles (particulate matter, or PM) and nitrogen dioxide (NO2), produced in part by industrial emissions and road traffic, are responsible for shortening the lifespans of city dwellers. Public transportation systems such as subways have thus seemed like a solution to reduce air pollution in the urban environment.

But what is the air like that we breathe underground, on the rail platforms and inside trains?

Mixed air quality

Over the last decade, several pioneering studies have monitored subway air quality across a range of cities in Europe, Asia and the Americas. The database is incomplete, but is growing and is already valuable.

Subway, Tokyo, 2016. Image: Mildiou/Flickr/creative commons.

For example, comparing air quality on subway, bus, tram and walking journeys from the same origin to the same destination in Barcelona, revealed that subway air had higher levels of air pollution than in trams or walking in the street, but slightly lower than those in buses. Similar lower values for subway environments compared to other public transport modes have been demonstrated by studies in Hong Kong, Mexico City, Istanbul and Santiago de Chile.

Of wheels and brakes

Such differences have been attributed to different wheel materials and braking mechanisms, as well as to variations in ventilation and air conditioning systems, but may also relate to differences in measurement campaign protocols and choice of sampling sites.

Second Avenue Subway in the making, New York, 2013. Image: MTA Capital Construction/Rehema Trimiew/Wikimedia Commons.

Key factors influencing subway air pollution will include station depth, date of construction, type of ventilation (natural/air conditioning), types of brakes (electromagnetic or conventional brake pads) and wheels (rubber or steel) used on the trains, train frequency and more recently the presence or absence of platform screen-door systems.

In particular, much subway particulate matter is sourced from moving train parts such as wheels and brake pads, as well as from the steel rails and power-supply materials, making the particles dominantly iron-containing.


To date, there is no clear epidemiological indication of abnormal health effects on underground workers and commuters. New York subway workers have been exposed to such air without significant observed impacts on their health, and no increased risk of lung cancer was found among subway train drivers in the Stockholm subway system.

But a note of caution is struck by the observations of scholars who found that employees working on the platforms of Stockholm underground, where PM concentrations were greatest, tended to have higher levels of risk markers for cardiovascular disease than ticket sellers and train drivers.

The dominantly ferrous particles are mixed with particles from a range of other sources, including rock ballast from the track, biological aerosols (such as bacteria and viruses), and air from the outdoors, and driven through the tunnel system on turbulent air currents generated by the trains themselves and ventilation systems.

Comparing platforms

The most extensive measurement programme on subway platforms to date has been carried out in the Barcelona subway system, where 30 stations with differing designs were studied under the frame of IMPROVE LIFE project with additional support from the AXA Research Fund.

It reveals substantial variations in particle-matter concentrations. The stations with just a single tunnel with one rail track separated from the platform by glass barrier systems showed on average half the concentration of such particles in comparison with conventional stations, which have no barrier between the platform and tracks. The use of air-conditioning has been shown to produce lower particle-matter concentrations inside carriages.

In trains where it is possible to open the windows, such as in Athens, concentrations can be shown generally to increase inside the train when passing through tunnels and more specifically when the train enters the tunnel at high speed.

According to their construction material, you may breath different kind of particles on various platforms worldwide. Image: London Tube/Wikimedia Commons.

Monitoring stations

Although there are no existing legal controls on air quality in the subway environment, research should be moving towards realistic methods of mitigating particle pollution. Our experience in the Barcelona subway system, with its considerable range of different station designs and operating ventilation systems, is that each platform has its own specific atmospheric micro environment.

To design solutions, one will need to take into account local conditions of each station. Only then can researchers assess the influences of pollution generated from moving train parts.

The ConversationSuch research is still growing and will increase as subway operating companies are now more aware about how cleaner air leads directly to better health for city commuters.

Fulvio Amato is a tenured scientist at the Spanish National Research CouncilTeresa Moreno is a tenured scientist at the Institute of Environmental Assessment and Water Research (IDAEA), Spanish Scientific Research Council CSIC.

This article was originally published on The Conversation. Read the original article.