When Kishore Seetharaman set out to understand how people with dementia move through Vancouver, he didn't send a survey—he walked the streets alongside them. What he discovered in those neighborhoods across Metro Vancouver challenges the way cities think about accessibility, and points toward a radical idea: that the people facing the greatest barriers should help design the solutions.
The research, published in the journal Cities, emerged from 14 one-on-one walks and interviews with people living with dementia navigating everyday urban terrain. Vancouver's sidewalks—cracked and uneven, dotted with construction detours and cyclists weaving unpredictably through pedestrian space—presented obstacles that go far beyond the obvious hazards of traffic. For people with dementia, these challenges pile on in ways city planners had largely overlooked. Poor sidewalk maintenance bred genuine fear of falling. Scooters and cyclists sharing walkways triggered anxiety. Street crossings—with their short signal times, high curbs, and turning vehicles—became sources of real stress. Public washrooms and places to rest weren't afterthoughts; they were necessities that often didn't exist.
What emerged most clearly, though, was something different from the typical accessibility conversation. People with dementia didn't primarily need ramps or handrails—though those mattered. They needed landmarks. They needed distinctiveness. They needed the urban environment itself to tell them where they were. Familiar artwork, graffiti, public installations, the particular character of a neighborhood—these weren't decorative. They were how someone found their way home.
"When it comes to urban design, their accessibility needs are often overlooked, not because of overt discrimination, but rather there's just a lack of knowledge and awareness about their needs," said Seetharaman, a post-doctoral fellow in the Department of Gerontology at Simon Fraser University. "We want to reframe the often paternalistic view of people living with dementia and focus on their lived experiences so we can make spaces more inclusive."
That reframing matters because the dementia community already faces what Seetharaman calls a "dual stigma"—the stigma of aging layered with discrimination rooted in living with cognitive change. When urban design ignores their needs on top of that, it sends a message about who cities are built for and who is left behind.
The researchers didn't stop at interviews. They brought their findings to municipal planners across the region, expecting perhaps polite pushback. Instead, they found receptiveness. Planners acknowledged real constraints—fragmented private developments creating inconsistencies in infrastructure, budget limits on public facility maintenance—but also genuine interest. "There is a willingness and interest from municipal planners to integrate lived experiences into design guidelines to inform planning," Seetharaman noted.
That openness points toward what Seetharaman calls the study's core insight: a more human-centered approach to urban design, one where legibility and distinctiveness aren't luxury add-ons but foundational principles. When a city designs for dementia, it designs better for everyone—for older adults, for people with visual impairments, for anyone navigating an unfamiliar neighborhood. The 14 people who walked Vancouver's streets with researchers didn't just share their struggles. They offered a blueprint for cities that work for all their residents, not just the ones cities currently remember to think about.