Research Summary: “Investigating Walking Environments In and Around Assisted Living Facilities.”

Photo courtesy of Susan Rodiek

Walking is the most popular form of exercise for elderly people. Photo courtesy of Susan Rodiek.

Speaking of older adults (see our last post about Environments for Aging), a good article – “Investigating Walking Environments in and Around Assisted Living Facilities: A Facility Visit Study” by Zhipeng Lu – was published in the Summer 2010 issue of Health Environments Research & Design Journal (HERD). I wish I could provide a web link for you to access the free article, but alas, it’s only available to buy. So I’ll summarize the author’s points here.

At issue are the dueling needs of elderly people: The need for safety and the need for exercise and social connection. Lu states that “falls are the most frequent cause of injury-related morbidity and mortality among community-dwelling older people.” Falling is a true risk and needs to be avoided. But as he (and others he cites) argue, exercise and social connection are both critical for maintaining physical and emotional health. Careful consideration of location/neighborhood, as well as design of indoor and outdoor pathways, can both reduce risks and enable elderly people to live active, healthy lives.

Lu first makes a case for the benefits of exercise – in this case, walking – for elderly people (people 65 or older), and asserts that “the physical environment plays a role in promoting physical activity.” Since walking is the most preferred form of exercise among elderly people, it makes good sense to see what types of settings best promote frequent and safe walking.” The design of walkable ALF environments has become more important because frail older people are increasingly averse to nursing homes and seek a higher quality of life and greater independent living in an ALF.” An assisted living facility, or ALF, as defined by the Assisted Living Federation of America is “a long-term care option that combines housing, supportive services, and healthcare for mentally and physically frail individuals.”

Lu’s research consists of visits to 34 ALFs in or near a major Texas city, where he observed walking environments and behaviors and conducted interviews with staff members. The goals of the study were to get a sense of the existing situation in and around ALFs, to develop hypotheses and research instruments for future research, and to provide recommendations for facilitating walkability in the siting, design and renovation of ALFs.

Great care should be taken when selecting sites and designing walking paths for ALFs. The following are important considerations:

Site selection – Neighborhood sidewalk systems
Lu found that many ALFs discourage residents from walking off-campus, especially if unattended, due to fears about crime or accidents (from falling or traffic). Interestingly, one ALF administrator noted that the incoming generation of Baby Boomers may be healthier and more active than previous generations and may therefore demand more independence and opportunities for exercise.

ALFs should ideally be located in densely populated areas with high land-use mixes and with easy access to destinations such as markets, movie theaters and restaurants. Even if residents are not able walk on their own, they can walk with family members or in groups, perhaps accompanied by a staff member.

“Land use patterns and neighborhood infrastructure (e.g., sidewalks, roadways, traffic lights) may be two important factors that affect ALF residents’ neighborhood walking behaviors. The former determine the number of destinations (e.g., grocery store, mall, restaurant) residents can walk to; the latter influences walking safety and comfort.”

With this in mind, ALFs should be located in neighborhoods that have a continuous sidewalk system so that residents can easily and safely walk off-campus. Other important features, even in neighborhoods that have sidewalks, are:

  • Roadways with low speed limits (30 mph or less)
  • Traffic lights for ease of pedestrian crossing
  • Traffic-calming devices (e.g., speed bumps and bump-outs)
  • Green buffers (lawns, flowerbeds, bushes) between path and roadway
  • Noticeable signage (e.g., “yield to pedestrian” signs), also for ease of pedestrian crossing

Walking off-campus not only facilitates exercise, but enables residents to retain their sense of independence and get out into the greater world.

Facility design – Promoting outdoor and indoor walking

Within ALF facilities, the following design features were found to be important for outdoor walking:

  • Looped walking paths/spaces “that support continuous footsteps, where residents are able to keep walking without having to turn back.” (Note: Research has also shown that looped pathways are the best choice for people with Alzheimer’s and other forms of dementia).
  • Shade from trees or shade structures to protect residents from overexposure to sunlight and heat. (Note: Not discussed in this article, but important to note is that strong, dark shadows on the ground plane – such as those made from pergolas with no netting or vegetation – create a phenomenon common in elderly people called “cliffing,” in which shadows are perceived as a grade change. This can lead to falls as people try to step up or down; therefore, strong shadows should be avoided).
  • Seating, which provides areas to rest; affords a sense of control; and encourages outdoor social interaction.
  • Pathways that are visible by staff from indoors, especially for frailer residents.
  • Paths wide enough to accommodate two peopleincluding two people with walkers, or one person in a walker and one in a wheelchair – to walk side by side. This further enables social interaction and safety.

For indoor walking areas, which are especially important in inclement weather (too hot or cold, rainy, icy, etc.) and for very frail people, corridors are the main venue and should be provided whenever possible. Important design features include:

  • Looped and unobstructed paths
  • Handrails
  • Plenty of seating
  • Window views, onto gardens or varied streetscapes, make walking more interesting and attractive: “They provide indoor walkers with a pleasant visual experience and a sense of connection with the outside world.”
  • Wayfinding and walking promotion signage.

On a programmatic level, walking groups – whether organized by the staff or by individual residents – seem to help motivate residents, and walking in a group both reduces the number of residents who could fall unattended and creates an opportunity for social connection as well as exercise.

Full citation:

Lu, Zhipeng (2010). “Investigating Walking Environments in and Around Assisted Living Facilities: A Facility Visit Study.” Health Environments Research & Design Journal (HERD), Summer, Vol. 3, No. 4, pp. 58-74.