B7. Enabling environments

Disability and the built environment

Aims and method:

Examines the role of the built environment on long-term trajectories of mobility disability in a national sample of American adults (age 45+) followed over a 15-year period. The study uses multilevel logistic growth curve models with nationally representative data from the Americans’ Changing Lives Study (1986–2001).

Key findings:

· Trajectories of mobility disability are steeper in older age groups.

· Women and those with lower education had higher odds of mobility disability over time.

· The presence of just one chronic health condition doubled the odds of mobility disability at each of the four study waves.

· Among older adults (age 75+), living in neighbourhoods characterised by more motorised travel was associated with an odds ratio for mobility disability that was 1.5 times higher in any given year than for older adults living in environments that were more pedestrian friendly.

Reference:

Clarke, P., Ailshire, J. & Lantz, P. (2009). Urban built environments and trajectories of mobility disability: Findings from a national sample of community-dwelling American adults (1986–2001), Social Science and Medicine, 69, 964-970

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759178/

Mobility, disability and the built environment

Aims and method:

Examines the effect of built environment characteristics on mobility disability among 1,195 adults aged 45 or more according to their level of lower extremity physical impairment. Built environment characteristics were assessed by using systematic social observation to independently rate street and sidewalk quality in the block surrounding each respondent’s residence in the city of Chicago (USA). Using multinomial logistic regression they were assessed against data from the Chicago Community Adult Health Study (2001–2003).

Key findings:

· Street conditions had no effect on outdoor mobility among adults with only mild or no physical impairment.

· Among adults with more severe impairment in neuromuscular and movement-related functions, the difference in the odd ratios for reporting severe mobility disability was over four times greater when at least one street was in fair or poor condition (characterised by cracks, potholes, or broken curbs).

· When all streets were in good condition, the odds of reporting mobility disability were attenuated in those with lower extremity impairment.

· If street quality could be improved, for those adults at greatest risk for disability in outdoor mobility, the disablement process could be slowed or even reversed.

Reference:

Clarke, P., Ailshire, J., Bader, M., Morenoff, J. & House, J. (2008). Mobility Disability and the Urban Built Environment, American Journal of Epidemiology, 168(5), 506-513

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727170/

Older mobility and disability in the built environment

Aims and method:

Explores associations between the built environment and mobility and disability in adults aged 60 years or older. Utilises a systematic review of objective evidence from seventeen empirical studies to with a particular focus on older adults amongst whom environmental effects are likely to be strongest

Key findings:

· Greater mobility is associated with higher street connectivity leading to shorter pedestrian distances needing to be travelled

· Better street conditions and safety against traffic (e.g. traffic calming), and proximity to destinations such as retail establishments, parks, and green spaces all increases mobility

Reference:

Rosso, A., Auchincloss, A. & Michael, Y. (2011). The Urban Built Environment and Mobility in Older Adults: A Comprehensive Review, Journal of Aging Research, 816106, 1-10

https://www.hindawi.com/journals/jar/2011/816106/

Built environment and the disablement process

Aims and method:

Examines the role of the built environment as a modifying factor in the pathway between lower extremity functional limitations and activities of daily living. The study uses hierarchical poisson regression analyses with data on older adults from central North Carolina (USA) and tested the effects of the broader context in which the Disablement Process takes place revealing ways in which in-dependence is constrained by the characteristics of the surrounding built environment.

Key findings:

· With declining physical function, older adults experience greater dependence in daily instrumental activities when they live in an environment characterised by limited land-use mixtures.

· Decreased diversity in local environments precipitates car dependence, which can have spill over effects on neighbourhood design, including a lack of continuous, safe sidewalks, and accessible public transit. In the Disablement Process, these structural barriers operate as “exacerbators”.

Reference:

Clarke, P. & George, L. (2005). The Role of the Built Environment in the Disablement Process, American Journal of Public Health, 95(11), 1933-1939

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449462/

Pedestrianisation and disability

Aims and method:

Investigates whether processes of pedestrianisation give rise to greater mobility amongst those with disability, and therefore whether claims that such schemes lead to ‘enabling’ environments are correct. The study draws on monitoring surveys of the phased pedestrianisation of the town centre in Kingston upon Thames (UK) to examine the mobility characteristics and movement patterns of disabled orange-badge holders (those registered disabled), elderly disabled and elderly people, and evaluates group levels of satisfaction with changes in the urban environment and accessibility to premises.

Key findings:

· Important contrasts in mobility experience are identified between different groups with mobility impairments. These relate, in measure, to health circumstances and degrees of mobility impairment.

· Pedestrianisation clearly benefits the majority of users, although the additional needs of orange-badge users were not fully met.

· Pedestrianisation schemes deliver a major achievement in urban design: not just for those with special mobility needs, but also for society at large.

Reference:

Grant, R. (1997). Pedestrianisation and Disabled People: A study of personal mobility in Kingston town centre, Disability and Society, 12(5), 723-740

http://www.tandfonline.com/doi/pdf/10.1080/09687599727010

Dementia and the outdoor environment

Aims and method:

Explores the relationship between the design of the built environment and the experience of adults with dementia. The study that involved older people with mild to moderate dementia taking two walks, one in a real town entre and one in a virtual reality simulation. Adaptations were made to the VR simulation to test the potential of a range of possible design improvements.

Key findings:

· Overall, the town centre posed relatively few problems for participants, although more difficulty was evident for those with greater impairment.

· Some features were liked more than others, particularly the segregation of pedestrian space from motor traffic either completely or through wider pavements.

· There were measurable benefits from using clear text based signage to support way-finding

· Older people with mild to moderate dementia should be encouraged to be active outdoors and this can be facilitated by small environmental modifications.

Reference:

Blackman, T., Van Schaik, P. & Martyr, A. (2007). Outdoor environments for people with dementia: an exploratory study using virtual reality, Ageing and Society, 27, 811-825

http://dro.dur.ac.uk/4019/1/4019.pdf?DDD34+dss0tb